Provider Demographics
NPI:1457184384
Name:PEREZ, CHRISTINA MARIA
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
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 1:1620 N CARPENTER RD STE D41
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1160
Mailing Address - Country:US
Mailing Address - Phone:209-523-3710
Mailing Address - Fax:
Practice Address - Street 1:1620 N CARPENTER RD STE D41
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1160
Practice Address - Country:US
Practice Address - Phone:209-523-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker