Healthcare Provider Details

I. General information

NPI: 1629641410
Provider Name (Legal Business Name): FELIPE PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W CAMERON AVE STE 310
WEST COVINA CA
91790-2726
US

IV. Provider business mailing address

134 CLOGSTON DR
LA PUENTE CA
91746-1815
US

V. Phone/Fax

Practice location:
  • Phone: 626-219-2400
  • Fax: 626-219-2558
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: