Provider Demographics
NPI:1467616151
Name:PEREZ, VANESSA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2021
Mailing Address - Country:US
Mailing Address - Phone:909-815-7231
Mailing Address - Fax:
Practice Address - Street 1:13193 CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4179
Practice Address - Country:US
Practice Address - Phone:909-902-9111
Practice Address - Fax:909-902-9199
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X, 225C00000X
CAPSY 24925103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No253J00000XAgenciesFoster Care Agency
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor