Healthcare Provider Details

I. General information

NPI: 1053869974
Provider Name (Legal Business Name): MARIA ELENA PEREZ MA,MFT, RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 I STREET
SACRAMENTO CA
95816
US

IV. Provider business mailing address

2701 I STREET
SACRAMENTO CA
95816
US

V. Phone/Fax

Practice location:
  • Phone: 916-835-4969
  • Fax: 916-473-7247
Mailing address:
  • Phone: 916-835-4969
  • Fax: 916-473-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number110585
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number372403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: