Provider Demographics
NPI:1649560905
Name:PERAZA, SANDRA IRENE (RDO)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:IRENE
Last Name:PERAZA
Suffix:
Gender:F
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 W SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3207
Mailing Address - Country:US
Mailing Address - Phone:559-298-8262
Mailing Address - Fax:
Practice Address - Street 1:426 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3207
Practice Address - Country:US
Practice Address - Phone:559-298-8262
Practice Address - Fax:559-298-7295
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL2416156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician