Provider Demographics
NPI:1639748213
Name:PEREY, DANELLE ESTRADA (LVN)
Entity Type:Individual
Prefix:MR
First Name:DANELLE
Middle Name:ESTRADA
Last Name:PEREY
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 CALLE SEGUNDA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-7506
Mailing Address - Country:US
Mailing Address - Phone:310-227-7060
Mailing Address - Fax:
Practice Address - Street 1:172 CALLE SEGUNDA
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7506
Practice Address - Country:US
Practice Address - Phone:310-227-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289111164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse