Basic Information
| Provider Information | |||||||||
| NPI: | 1225227671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERILLA | ||||||||
| FirstName: | JESSENIA | ||||||||
| MiddleName: | YVETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8337 TELEGRAPH RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906604957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628623644 | ||||||||
| FaxNumber: | 5628655244 | ||||||||
| Practice Location | |||||||||
| Address1: | 8337 TELEGRAPH RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906604957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628623644 | ||||||||
| FaxNumber: | 5628655244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | ASW67341 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.