Healthcare Provider Details

I. General information

NPI: 1629418876
Provider Name (Legal Business Name): ALEJANDRA VACA-PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 IOOF AVE
GILROY CA
95020-5204
US

IV. Provider business mailing address

290 IOOF AVE
GILROY CA
95020-5204
US

V. Phone/Fax

Practice location:
  • Phone: 408-846-2100
  • Fax: 408-842-8815
Mailing address:
  • Phone: 408-846-2100
  • Fax: 408-842-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number36752
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number36752
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87405
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number36752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: