Healthcare Provider Details

I. General information

NPI: 1437200375
Provider Name (Legal Business Name): CARLOS ANTHONY PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 LOMA LINDA DR
BAKERSFIELD CA
93305-2437
US

IV. Provider business mailing address

2425 LOMA LINDA DR
BAKERSFIELD CA
93305-2437
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-8280
  • Fax:
Mailing address:
  • Phone: 661-326-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: