Provider Demographics
NPI:1467898148
Name:PEREZ, NANCY (CRC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S ATLANTIC BLVD
Mailing Address - Street 2:101
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1200
Mailing Address - Country:US
Mailing Address - Phone:323-318-9960
Mailing Address - Fax:323-780-3211
Practice Address - Street 1:2450 S ATLANTIC BLVD
Practice Address - Street 2:101
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1200
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:323-780-3211
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL