Healthcare Provider Details

I. General information

NPI: 1710776000
Provider Name (Legal Business Name): TRACIE FERNANDES-PEREZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 PARKS AVE
LA MESA CA
91941-6212
US

IV. Provider business mailing address

1462 RED BARK RD
ESCONDIDO CA
92029-4107
US

V. Phone/Fax

Practice location:
  • Phone: 619-668-5730
  • Fax:
Mailing address:
  • Phone: 408-691-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: