Provider Demographics
NPI:1891200200
Name:PEREZ, FRANK CORREA
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:CORREA
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 1:9464 9TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3483
Mailing Address - Country:US
Mailing Address - Phone:760-532-8234
Mailing Address - Fax:
Practice Address - Street 1:9464 9TH AVE STE A
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3483
Practice Address - Country:US
Practice Address - Phone:760-532-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XMedicaid