Provider Demographics
NPI:1578839635
Name:PEREZ, MARIACRUZ MONICA (MS, RD)
Entity Type:Individual
Prefix:
First Name:MARIACRUZ
Middle Name:MONICA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SOUTHBURY CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1377
Mailing Address - Country:US
Mailing Address - Phone:916-595-7727
Mailing Address - Fax:
Practice Address - Street 1:29 SOUTHBURY CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95835-1377
Practice Address - Country:US
Practice Address - Phone:916-595-7727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA892546133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered