Healthcare Provider Details

I. General information

NPI: 1346453578
Provider Name (Legal Business Name): MR. JOB PEREZ JR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOB PEREZ JR. M.A.

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 LIMONITE AVE STE A
JURUPA VALLEY CA
92509-6120
US

IV. Provider business mailing address

8175 LIMONITE AVE STE A
JURUPA VALLEY CA
92509-6120
US

V. Phone/Fax

Practice location:
  • Phone: 866-222-2930
  • Fax:
Mailing address:
  • Phone: 866-222-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT85904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: