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General NPI Number Information
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NPI Number | 1326109190
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Entity Type | Individual
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Provider Name | MARVIN PEREZ PH.D
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 2071 HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93611-6101
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Country | US
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Telephone | 559-324-5574
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Fax | 559-324-5575
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Provider Business Mailing Address
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Address Line | 2071 HERDON AVENUE
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City | CLOVIS
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State | CA
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Zip | 93611-0361
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Country | US
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Telephone |
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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 | PSY14610
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License Number State | CA
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