Provider Demographics
NPI:1093289613
Name:PEREZ, NICOLE DENY
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENY
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 1:875 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3311
Mailing Address - Country:US
Mailing Address - Phone:209-633-3057
Mailing Address - Fax:209-444-8905
Practice Address - Street 1:875 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3311
Practice Address - Country:US
Practice Address - Phone:209-633-3057
Practice Address - Fax:209-444-8905
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional