Provider Demographics
NPI:1821385626
Name:PEREA-PEREZ, DIANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:PEREA-PEREZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3900
Mailing Address - Country:US
Mailing Address - Phone:559-297-5697
Mailing Address - Fax:559-297-5697
Practice Address - Street 1:900 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3900
Practice Address - Country:US
Practice Address - Phone:559-297-5697
Practice Address - Fax:559-297-5697
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47232183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist