Provider Demographics
NPI:1548576929
Name:PEREZ, NANCEE RENEE
Entity Type:Individual
Prefix:MRS
First Name:NANCEE
Middle Name:RENEE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCEE
Other - Middle Name:RENEE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:506 S MADRONA AVE
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5353
Mailing Address - Country:US
Mailing Address - Phone:714-529-4618
Mailing Address - Fax:
Practice Address - Street 1:18200 YORBA LINDA BOULEVARD
Practice Address - Street 2:SUITE 401
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-646-8010
Practice Address - Fax:714-572-2562
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA914619133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered