Provider Demographics
NPI:1336903061
Name:PEREZ, NOEMI GUADALUPE
Entity Type:Individual
Prefix:MISS
First Name:NOEMI
Middle Name:GUADALUPE
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 1:801 COPERATE CENTER DRIVE SUIT 210
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91761
Mailing Address - Country:US
Mailing Address - Phone:909-634-3974
Mailing Address - Fax:855-864-1494
Practice Address - Street 1:801 COPERATE CENTER DRIVE SUIT 210
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-634-3974
Practice Address - Fax:855-864-1494
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician