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General NPI Number Information
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NPI Number | 1629322102
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Entity Type | Individual
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Provider Name | ANNA L. PEREZ R.A.S.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 4459 VOLTAIRE DRIVE
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City | CAMERON PARK
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State | CA
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Zip | 95682-7309
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Country | US
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Telephone | 530-676-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 4459 VOLTAIRE DR
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City | CAMERON PARK
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State | CA
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Zip | 95682-7309
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Country | US
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Telephone | 530-409-2067
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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 | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | 942535820
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License Number State | CA
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