Provider Demographics
NPI:1659716710
Name:PEREZ, KHARLA KAY DIZON (BSN,RN)
Entity Type:Individual
Prefix:
First Name:KHARLA KAY
Middle Name:DIZON
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:KHARLA KAY
Other - Middle Name:ISAAC
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN,RN
Mailing Address - Street 1:3853 ROSECRANS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:619-692-8232
Mailing Address - Fax:619-542-4060
Practice Address - Street 1:3853 ROSECRANS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8232
Practice Address - Fax:619-542-4060
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA805684163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult