Basic Information
| Provider Information | |||||||||
| NPI: | 1467616151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3476 BUCKINGHAM RD | ||||||||
| Address2: | |||||||||
| City: | CHINO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917092021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098157231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13193 CENTRAL AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917104179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099029111 | ||||||||
| FaxNumber: | 9099029199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2008 | ||||||||
| LastUpdateDate: | 11/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 253J00000X | N | Agencies | Foster Care Agency | 225C00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 103TC0700X | PSY 24925 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.