Provider Demographics
NPI:1407438773
Name:FELICIANO PEREZ, GLORIDEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIDEL
Middle Name:
Last Name:FELICIANO PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 REDHILL AVE RM 303
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5517
Mailing Address - Country:US
Mailing Address - Phone:787-219-3873
Mailing Address - Fax:
Practice Address - Street 1:2001 E 4TH ST STE 200205
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3916
Practice Address - Country:US
Practice Address - Phone:714-824-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025944103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical