Provider Demographics
NPI:1477959161
Name:PEREZ MEDINA, JEREEN (NP)
Entity Type:Individual
Prefix:
First Name:JEREEN
Middle Name:
Last Name:PEREZ MEDINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEREEN
Other - Middle Name:P
Other - Last Name:MEDINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8110 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3603
Mailing Address - Country:US
Mailing Address - Phone:909-822-1164
Mailing Address - Fax:
Practice Address - Street 1:8110 MANGO AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-427-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily