MEDICARE: PAULA PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPCC8673	CA

General Provider Information

NPI Number	:	1639779101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA PEREZ

Provider Business Mailing Address
First Line	:	5882 ADOBE FALLS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4600
Country	:	US
Telephone Number	:	352-682-2239
Fax Number	:

Provider Business Practice Location Address
First Line	:	5882 ADOBE FALLS RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-4600
Country	:	US
Telephone Number	:	352-682-2239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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Directions to “ PAULA PEREZ ” Practice Location

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