Provider Demographics
NPI:1033456934
Name:PEREZ, BRENDA DENISE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:DENISE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 E. STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90021
Mailing Address - Country:US
Mailing Address - Phone:213-623-8446
Mailing Address - Fax:213-896-1880
Practice Address - Street 1:838 EST. 6TH TREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90021
Practice Address - Country:US
Practice Address - Phone:213-623-8446
Practice Address - Fax:213-896-1880
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health