Provider Demographics
NPI:1639982507
Name:YERENA-PEREZ, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:YERENA-PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 FREEDOM BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2777
Mailing Address - Country:US
Mailing Address - Phone:559-287-8934
Mailing Address - Fax:
Practice Address - Street 1:1205 FREEDOM BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2777
Practice Address - Country:US
Practice Address - Phone:559-287-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker