Healthcare Provider Details

I. General information

NPI: 1437273489
Provider Name (Legal Business Name): PERLA IVETTE PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PERLA I PEREZ LCSW

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NATIVIDAD RD RM 200
SALINAS CA
93906-3122
US

IV. Provider business mailing address

2140 MERCED ST STE 101
FRESNO CA
93721-1721
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4510
  • Fax:
Mailing address:
  • Phone: 831-214-4825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: