Provider Demographics
NPI:1093968125
Name:PERDICES, MIGUEL A (CATC)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:PERDICES
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2417
Mailing Address - Country:US
Mailing Address - Phone:415-762-3712
Mailing Address - Fax:415-865-0119
Practice Address - Street 1:2020 HAYES ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1128
Practice Address - Country:US
Practice Address - Phone:415-213-1920
Practice Address - Fax:415-386-2048
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADE CATC 092117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)