Provider Demographics
NPI:1730694936
Name:PEREZ, BRIANA NICOLE (SLP)
Entity type:Individual
Prefix:MISS
First Name:BRIANA
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6949 LAGUNA PL # B1
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6128
Mailing Address - Country:US
Mailing Address - Phone:626-399-7190
Mailing Address - Fax:
Practice Address - Street 1:147 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3407
Practice Address - Country:US
Practice Address - Phone:626-355-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-10
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39542355S0801X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant