Provider Demographics
NPI:1912247461
Name:PEREZ, AMANDA RENEE (BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RENEE
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6846
Mailing Address - Country:US
Mailing Address - Phone:562-236-7908
Mailing Address - Fax:
Practice Address - Street 1:1901 E LAMBERT RD STE 203Q
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-5756
Practice Address - Country:US
Practice Address - Phone:562-298-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9007103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst