Provider Demographics
NPI:1730790635
Name:MEJIA-PEREZ, BERENICE
Entity type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:MEJIA-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 1:28191 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9570
Mailing Address - Country:US
Mailing Address - Phone:323-702-5661
Mailing Address - Fax:
Practice Address - Street 1:28191 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:NUEVO
Practice Address - State:CA
Practice Address - Zip Code:92567-9570
Practice Address - Country:US
Practice Address - Phone:323-702-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician