Healthcare Provider Details

I. General information

NPI: 1215864657
Provider Name (Legal Business Name): JUSTINA BIANCA PEREA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2236 YUKON ST
CONCORD CA
94520-1349
US

IV. Provider business mailing address

PO BOX 5206
WALNUT CREEK CA
94596-1206
US

V. Phone/Fax

Practice location:
  • Phone: 925-348-7684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: