Provider Demographics
NPI:1295334043
Name:PEREZ, CALLISTA
Entity type:Individual
Prefix:
First Name:CALLISTA
Middle Name:
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 1:2020 NE LINNEA DR APT 309
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4975
Mailing Address - Country:US
Mailing Address - Phone:541-784-6546
Mailing Address - Fax:
Practice Address - Street 1:2020 NE LINNEA DR APT 309
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4975
Practice Address - Country:US
Practice Address - Phone:541-784-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician