Provider Demographics
NPI:1598744310
Name:PEREZ, SANDRA ELIZABETH (MSN CNS)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSN CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 AMY WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4501
Mailing Address - Country:US
Mailing Address - Phone:951-369-3381
Mailing Address - Fax:951-274-7754
Practice Address - Street 1:3908 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3522
Practice Address - Country:US
Practice Address - Phone:951-274-7744
Practice Address - Fax:951-274-7754
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA208624OtherREGISTERED NURSE
CA530OtherCLINICAL NURSE SPECIALIST
CA530OtherCLINICAL NURSE SPECIALIST
CAZZZ15873ZMedicare ID - Type UnspecifiedPROVIDER NUMBER