Provider Demographics
NPI:1801324892
Name:PEREZ, AIMEE JAQUELYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AIMEE JAQUELYN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ANAHEIM BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3872
Mailing Address - Country:US
Mailing Address - Phone:714-876-7401
Mailing Address - Fax:
Practice Address - Street 1:100 S ANAHEIM BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3872
Practice Address - Country:US
Practice Address - Phone:714-876-7401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54507363AM0700X
CA54507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical