Provider Demographics
NPI:1407052566
Name:PEREZ, MARIO
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4303
Mailing Address - Country:US
Mailing Address - Phone:805-922-2243
Mailing Address - Fax:805-349-8165
Practice Address - Street 1:201 W CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4303
Practice Address - Country:US
Practice Address - Phone:805-922-2243
Practice Address - Fax:805-349-8165
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator