Basic Information
| Provider Information | |||||||||
| NPI: | 1023137304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | BENZION | ||||||||
| MiddleName: | ISA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1830 S CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932774418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5597302969 | ||||||||
| FaxNumber: | 5597302991 | ||||||||
| Practice Location | |||||||||
| Address1: | 5330 SAN BERNARDINO ST | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917632952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264256875 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 49919 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 106H00000X | LMFT49919 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7564A | 01 | CA | THE VILLAGE FAMILY SERVICES | OTHER | 7817A | 01 | CA | CHILDREN'S INSTITIUTE, INC | OTHER |