Provider Demographics
NPI:1184400558
Name:PEREZ, LORI JEAN (MSW STUDENT INTERN)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JEAN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSW STUDENT INTERN
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:JEAN
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1407 FOOTHILL BLVD. #131
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:949-247-1776
Mailing Address - Fax:
Practice Address - Street 1:1126 W. FOOTHILL BLVD. SUITE 110
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-985-0513
Practice Address - Fax:909-985-7193
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program