Provider Demographics
NPI:1902460868
Name:PEREZ, LEANDRO JR
Entity Type:Individual
Prefix:MR
First Name:LEANDRO
Middle Name:
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LEANDRO
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:CERTIFIED C139530723
Mailing Address - Street 1:2180 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3325
Mailing Address - Country:US
Mailing Address - Phone:909-554-9457
Mailing Address - Fax:909-865-1831
Practice Address - Street 1:2180 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3325
Practice Address - Country:US
Practice Address - Phone:909-865-2336
Practice Address - Fax:909-865-1831
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAC139530723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator