Basic Information
| Provider Information | |||||||||
| NPI: | 1760602858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | FLORA | ||||||||
| MiddleName: | IRENE | ||||||||
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| Credential: | MSW, ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1440 TOURS COURT | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098001699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1330 W RAMSEY ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | BANNING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922204477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518497142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 05/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.