Provider Demographics
NPI:1821857590
Name:PEREZ, CHLOE DANIELLE (RBT)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:DANIELLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W FL 17
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5905
Mailing Address - Country:US
Mailing Address - Phone:171-470-7280
Mailing Address - Fax:949-534-6756
Practice Address - Street 1:333 CITY BLVD W FL 17
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5905
Practice Address - Country:US
Practice Address - Phone:714-707-2805
Practice Address - Fax:949-534-6756
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-21-175927106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician