Healthcare Provider Details

I. General information

NPI: 1407341803
Provider Name (Legal Business Name): MISS IRMA JEANETTE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 3RD ST STE 400
SAN FRANCISCO CA
94124-1409
US

IV. Provider business mailing address

PO BOX 423
WALNUT CREEK CA
94597-0423
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC16388
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: