Provider Demographics
NPI:1053020057
Name:PERDOMO-PAZ, ADRIANA CONSTANZA (CPR, CAREGIVER, ECM)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:CONSTANZA
Last Name:PERDOMO-PAZ
Suffix:
Gender:F
Credentials:CPR, CAREGIVER, ECM
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:CONSTANZA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPR, CAREGIVER, ECM
Mailing Address - Street 1:3657 CUBRE TER
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6770
Mailing Address - Country:US
Mailing Address - Phone:530-965-7881
Mailing Address - Fax:
Practice Address - Street 1:3657 CUBRE TER
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-6770
Practice Address - Country:US
Practice Address - Phone:530-965-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962037838OtherCARELINX