Provider Demographics
NPI:1346453578
Name:PEREZ JR, JOB
Entity Type:Individual
Prefix:MR
First Name:JOB
Middle Name:
Last Name:PEREZ JR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOB
Other - Middle Name:
Other - Last Name:PEREZ JR.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:8175 LIMONITE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-6120
Mailing Address - Country:US
Mailing Address - Phone:866-222-2930
Mailing Address - Fax:
Practice Address - Street 1:8175 LIMONITE AVE STE A
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-6120
Practice Address - Country:US
Practice Address - Phone:866-222-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT85904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist