Provider Demographics
NPI:1922744390
Name:PEREZ MEDINA, CHRISTEL MAGDALENA (N/A)
Entity Type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:MAGDALENA
Last Name:PEREZ MEDINA
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-2002
Mailing Address - Country:US
Mailing Address - Phone:323-713-3488
Mailing Address - Fax:
Practice Address - Street 1:3580 E 52ND ST
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2002
Practice Address - Country:US
Practice Address - Phone:323-713-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY2314710OtherID