Healthcare Provider Details

I. General information

NPI: 1336618891
Provider Name (Legal Business Name): ERIN P PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E 700 S STE 102
AMERICAN FORK UT
84003-3389
US

IV. Provider business mailing address

PO BOX 572070
MURRAY UT
84157-2070
US

V. Phone/Fax

Practice location:
  • Phone: 800-949-4864
  • Fax:
Mailing address:
  • Phone: 801-263-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6903657-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: