Healthcare Provider Details

I. General information

NPI: 1447569215
Provider Name (Legal Business Name): MARIA ANTONIA PEREZ BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA ANTONIA LOPEZ

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47825 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

47825 OASIS ST
INDIO CA
92201-6950
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8262
  • Fax: 760-393-3215
Mailing address:
  • Phone: 760-863-8562
  • Fax: 760-393-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: