Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 7504 | CA |
NPI | 1063414019 |
---|---|
Provider Name | Janel Keeling Perez |
First Address | North Hills, CA 91343-2036 |
Second Address | North Hills, CA 91343-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2005 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q09487 | (02) | CA |