Provider Demographics
NPI:1972297091
Name:PEREZ, JESSICA (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 N CONWELL AVE APT 323
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-1335
Mailing Address - Country:US
Mailing Address - Phone:626-502-3229
Mailing Address - Fax:
Practice Address - Street 1:1159 N CONWELL AVE APT 323
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-1335
Practice Address - Country:US
Practice Address - Phone:626-502-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 332B00000X, 251F00000X, 251J00000X
CAVN710993164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care