Provider Demographics
NPI:1871792176
Name:REED PEREZ, WENDY DAWN (PA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DAWN
Last Name:REED PEREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-335-8649
Mailing Address - Fax:909-557-1924
Practice Address - Street 1:6700 N 1ST ST
Practice Address - Street 2:SUITE 131
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3900
Practice Address - Country:US
Practice Address - Phone:559-432-3333
Practice Address - Fax:559-432-3336
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12995363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA12995OtherPHYSICIAN ASSISTANT LICEN