1245442482 NPI number — MS. ROXANE JULIET PEREZ NURSE PRACTITIONER

Table of content: MS. ROXANE JULIET PEREZ NURSE PRACTITIONER (NPI 1245442482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245442482 NPI number — MS. ROXANE JULIET PEREZ NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
ROXANE
Provider Middle Name:
JULIET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEMOS
Provider Other First Name:
ROXANE
Provider Other Middle Name:
JULIET
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245442482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6830
Provider Second Line Business Mailing Address:
CSUF STUDENT HEALTH AND COUSSELING CENTER
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92834-3069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
657-278-2800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N. ST COLLEGE BLVD
Provider Second Line Business Practice Location Address:
STUDENT HEALTH AND COUNSELING CENTER
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92834-3069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
657-278-2800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP 16948 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)