Provider Demographics
NPI:1225369549
Name:PEREZ, ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26552 BRANDON
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-4193
Mailing Address - Country:US
Mailing Address - Phone:949-371-3574
Mailing Address - Fax:
Practice Address - Street 1:26440 LA ALAMEDA
Practice Address - Street 2:STE 220
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6304
Practice Address - Country:US
Practice Address - Phone:949-371-3574
Practice Address - Fax:858-312-8460
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23295103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist