Healthcare Provider Details

I. General information

NPI: 1093385916
Provider Name (Legal Business Name): ANGELA PEREZ LMT, CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 AVIATION BLVD STE D
SANTA ROSA CA
95403-1074
US

IV. Provider business mailing address

418 AVIATION BLVD STE D
SANTA ROSA CA
95403-1074
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-6258
  • Fax: 707-284-0122
Mailing address:
  • Phone: 707-541-6258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: