Provider Demographics
NPI:1023137304
Name:PEREZ, BENZION ISA
Entity type:Individual
Prefix:
First Name:BENZION
Middle Name:ISA
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 1:1830 S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4418
Mailing Address - Country:US
Mailing Address - Phone:559-730-2969
Mailing Address - Fax:559-730-2991
Practice Address - Street 1:5330 SAN BERNARDINO ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2952
Practice Address - Country:US
Practice Address - Phone:626-425-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49919106H00000X
225400000X
CALMFT49919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7564AOtherTHE VILLAGE FAMILY SERVICES
CA7817AOtherCHILDREN'S INSTITIUTE, INC
CA7564AOtherTHE VILLAGE FAMILY SERVICES