Provider Demographics
NPI:1770310450
Name:PEREZ, STEPHANIE JASMINE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JASMINE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18523 CORWIN RD STE H
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2300
Mailing Address - Country:US
Mailing Address - Phone:760-242-3005
Mailing Address - Fax:760-503-1375
Practice Address - Street 1:18523 CORWIN RD STE H
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2300
Practice Address - Country:US
Practice Address - Phone:760-242-3005
Practice Address - Fax:760-503-1375
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker