Healthcare Provider Details

I. General information

NPI: 1720723901
Provider Name (Legal Business Name): DINA L PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S COAST DR STE 260
COSTA MESA CA
92626-7719
US

IV. Provider business mailing address

940 S COAST DR STE 260
COSTA MESA CA
92626-7719
US

V. Phone/Fax

Practice location:
  • Phone: 949-524-4313
  • Fax:
Mailing address:
  • Phone: 714-866-8043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: