Provider Demographics
NPI:1508053463
Name:PEREZ, ANGELICA D (PA-C)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:D
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:PEREZ-ROMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:ONE UNIVERSITY CIRCLE
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:209-667-3396
Mailing Address - Fax:209-667-3195
Practice Address - Street 1:1 UNIVERSITY CIR
Practice Address - Street 2:CSU STANISLAUS, STUDENT HEALTH CENTER
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-3200
Practice Address - Country:US
Practice Address - Phone:209-667-3396
Practice Address - Fax:209-667-3195
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19347363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical