Provider Demographics
NPI:1407527104
Name:PEREZ, MOISES
Entity Type:Individual
Prefix:
First Name:MOISES
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 1:4205 W FIGARDEN DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6051
Mailing Address - Country:US
Mailing Address - Phone:559-221-1680
Mailing Address - Fax:559-221-4336
Practice Address - Street 1:4205 W FIGARDEN DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6051
Practice Address - Country:US
Practice Address - Phone:559-221-1680
Practice Address - Fax:559-221-4336
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner