Provider Demographics
NPI:1295833242
Name:PEREZ, JUAN CAZARES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CAZARES
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 BELL ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2938
Mailing Address - Country:US
Mailing Address - Phone:323-481-1852
Mailing Address - Fax:800-307-9438
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:800-314-7273
Practice Address - Fax:800-307-9438
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#14184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP14184AMedicare ID - Type UnspecifiedMEDICARE PROVDER NUMBER