Provider Demographics
NPI:1720126378
Name:JAMES-PEREZ, SAMANTHA ELIZABETH (LPT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:JAMES-PEREZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:MS
Other - First Name:SAMANTHA
Other - Middle Name:ELIZABETH
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:15734 BLUFFSIDE CT UNIT 189
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3890
Mailing Address - Country:US
Mailing Address - Phone:909-606-3836
Mailing Address - Fax:
Practice Address - Street 1:902 S MYRTLE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3427
Practice Address - Country:US
Practice Address - Phone:626-303-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30039167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician