Provider Demographics
NPI:1710856653
Name:PEREZ, JOSE JAVIER
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name: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 1:11155 BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5202
Mailing Address - Country:US
Mailing Address - Phone:909-966-7354
Mailing Address - Fax:
Practice Address - Street 1:11155 BOLTON AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-5202
Practice Address - Country:US
Practice Address - Phone:909-966-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist