Provider Demographics
NPI:1578186573
Name:PERIDA, JOSE GIOVANNI SANTOS
Entity Type:Individual
Prefix:MR
First Name:JOSE GIOVANNI
Middle Name:SANTOS
Last Name:PERIDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3245
Mailing Address - Country:US
Mailing Address - Phone:805-387-4327
Mailing Address - Fax:
Practice Address - Street 1:5000 W OAKEY BLVD STE B8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3395
Practice Address - Country:US
Practice Address - Phone:702-202-6158
Practice Address - Fax:702-202-6772
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-26
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health