Provider Demographics
NPI:1821377888
Name:PEREZ, JOSE JUAN
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JUAN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 ATLANTA AVE
Mailing Address - Street 2:D2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7419
Mailing Address - Country:US
Mailing Address - Phone:951-955-8210
Mailing Address - Fax:951-955-8164
Practice Address - Street 1:1827 ATLANTA AVE
Practice Address - Street 2:D2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7419
Practice Address - Country:US
Practice Address - Phone:951-955-8210
Practice Address - Fax:951-955-8164
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator