Provider Demographics
NPI:1528869724
Name:PEREZ CARMONA, ESEQUIEL
Entity type:Individual
Prefix:
First Name:ESEQUIEL
Middle Name:
Last Name:PEREZ CARMONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ZEKE
Other - Middle Name:
Other - Last Name:PEREZ CARMONA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA, AA
Mailing Address - Street 1:1760 S LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8520
Mailing Address - Country:US
Mailing Address - Phone:805-437-2904
Mailing Address - Fax:805-987-2367
Practice Address - Street 1:1760 S LEWIS RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8520
Practice Address - Country:US
Practice Address - Phone:805-437-2904
Practice Address - Fax:805-987-2367
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator