Provider Demographics
NPI:1295861920
Name:PEREZ, SAL THOMAS (BS)
Entity Type:Individual
Prefix:MR
First Name:SAL
Middle Name:THOMAS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N 2ND ST
Mailing Address - Street 2:APT. B
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1358
Mailing Address - Country:US
Mailing Address - Phone:626-457-8667
Mailing Address - Fax:
Practice Address - Street 1:3100 S HARBOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6823
Practice Address - Country:US
Practice Address - Phone:714-966-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health