Provider Demographics
NPI:1649340365
Name:PEREZ, GABRIELLA B (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:B
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S FULLER AVE APT 9K
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-5393
Mailing Address - Country:US
Mailing Address - Phone:559-269-2045
Mailing Address - Fax:
Practice Address - Street 1:5519 GROSVENOR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6994
Practice Address - Country:US
Practice Address - Phone:310-305-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 15502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist