Provider Demographics
NPI:1750157939
Name:PEREZ, ALYSSA (CPT1/ MA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CPT1/ MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46583 DAISY ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5731
Mailing Address - Country:US
Mailing Address - Phone:951-922-5239
Mailing Address - Fax:760-683-6991
Practice Address - Street 1:46583 DAISY ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5731
Practice Address - Country:US
Practice Address - Phone:951-922-5239
Practice Address - Fax:760-683-6991
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC8D2F6HS246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy