Provider Demographics
NPI:1023807088
Name:PEREZ, MIRYAN P
Entity type:Individual
Prefix:MS
First Name:MIRYAN
Middle Name:P
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21732 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2179
Mailing Address - Country:US
Mailing Address - Phone:310-781-3412
Mailing Address - Fax:310-781-3412
Practice Address - Street 1:21732 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2179
Practice Address - Country:US
Practice Address - Phone:310-781-3412
Practice Address - Fax:310-781-3412
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator