Provider Demographics
NPI:1255154498
Name:PEREZ AGUAYO, NOEMI LOURDES
Entity type:Individual
Prefix:
First Name:NOEMI LOURDES
Middle Name:
Last Name:PEREZ AGUAYO
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 1:5741 LAS VIRGENES RD STE A
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1273
Mailing Address - Country:US
Mailing Address - Phone:818-712-8250
Mailing Address - Fax:
Practice Address - Street 1:5741 LAS VIRGENES RD STE A
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1273
Practice Address - Country:US
Practice Address - Phone:818-712-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-24-77148103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty