Healthcare Provider Details

I. General information

NPI: 1326170382
Provider Name (Legal Business Name): KRISTINE H PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 W 10TH PL # S100
MESA AZ
85201-3497
US

IV. Provider business mailing address

3877 N 7TH ST # S400
PHOENIX AZ
85014-5072
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax:
Mailing address:
  • Phone: 602-258-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW15744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23355
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: