Healthcare Provider Details

I. General information

NPI: 1073888442
Provider Name (Legal Business Name): MIGRAL PEREZ JR. SUDCC 15298
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2012
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 W. PCH LONG BEACH CA. 90806
LONG BEACH CA
90806
US

IV. Provider business mailing address

514 W. PCH LONG BEACH CA. 90806
LONG BEACH CA
90806
US

V. Phone/Fax

Practice location:
  • Phone: 562-432-0713
  • Fax:
Mailing address:
  • Phone: 562-432-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15298
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN235277
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: