Healthcare Provider Details

I. General information

NPI: 1225800758
Provider Name (Legal Business Name): AUDREY INES PEREZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5994 W LAS POSITAS BLVD STE 115
PLEASANTON CA
94588-8525
US

IV. Provider business mailing address

PO BOX 7252
REDLANDS CA
92375-0252
US

V. Phone/Fax

Practice location:
  • Phone: 925-515-6347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1622353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: