Healthcare Provider Details

I. General information

NPI: 1225966328
Provider Name (Legal Business Name): RODOLFO ABRAHAM PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 W BIG BEAVER RD STE 109
TROY MI
48084-3006
US

IV. Provider business mailing address

780 TOWN CENTER DR
DEARBORN MI
48126-2996
US

V. Phone/Fax

Practice location:
  • Phone: 248-385-5756
  • Fax:
Mailing address:
  • Phone: 779-435-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362010281
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: