Healthcare Provider Details

I. General information

NPI: 1477000149
Provider Name (Legal Business Name): NICOLE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

V. Phone/Fax

Practice location:
  • Phone: 510-746-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number113620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: