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General NPI Number Information
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NPI Number | 1225966328
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Entity Type | Individual
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Provider Name | RODOLFO ABRAHAM PEREZ
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Gender | Male
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 3155 W BIG BEAVER RD STE 109
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City | TROY
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State | MI
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Zip | 48084-3006
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Country | US
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Telephone | 248-385-5756
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Fax |
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Provider Business Mailing Address
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Address Line | 780 TOWN CENTER DR
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City | DEARBORN
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State | MI
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Zip | 48126-2996
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Country | US
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Telephone | 779-435-9064
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6362010281
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License Number State | MI
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