Provider Demographics
NPI:1154728582
Name:PEREZ, REYNA DAYANA
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:DAYANA
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 1:8558 ELBURG ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-8634
Mailing Address - Country:US
Mailing Address - Phone:310-733-7448
Mailing Address - Fax:
Practice Address - Street 1:8558 ELBURG ST UNIT C
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-8634
Practice Address - Country:US
Practice Address - Phone:310-733-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130215705101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool