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NPI Code Detail

MEDICARE: MRS. GLORIA PEREZ NEVAREZ SUDCC 17223

MEDICARE: MRS. GLORIA PEREZ NEVAREZ SUDCC 17223
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor17223CA

General Provider Information

NPI Number : 1235082470
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLORIA PEREZ NEVAREZ SUDCC 17223
Provider Business Mailing Address
First Line : 431 NORTH ST # B
Second Line :
City : HEALDSBURG
State : CA
Zip : 95448-4211
Country : US
Telephone Number : 415-459-2395
Fax Number :
Provider Business Practice Location Address
First Line : 1477 LINCOLN AVE
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-2028
Country : US
Telephone Number : 415-459-2395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2026
Last Update Date : 02/17/2026

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