Basic Information
| Provider Information | |||||||||
| NPI: | 1477702793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | LETICIA | ||||||||
| MiddleName: | JIMENEZ | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6475 VIA DEL RANCHO | ||||||||
| Address2: | |||||||||
| City: | CHINO HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917093921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143519217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1160 S GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDORA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263355980 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2008 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW81591 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.