Provider Demographics
NPI:1447578547
Name:MENDEZ, IRMA PEREZ (COUNSELOR ADDICTION)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:PEREZ
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:COUNSELOR ADDICTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE. SUITE310A ROSEVILLE CA. 95661
Mailing Address - Street 2:1530 THIRD STREET, SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648
Mailing Address - Country:US
Mailing Address - Phone:916-434-8927
Mailing Address - Fax:916-434-0678
Practice Address - Street 1:1530 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2501
Practice Address - Country:US
Practice Address - Phone:916-434-8927
Practice Address - Fax:916-434-0678
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31-001-04-120251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XMedicare PIN
CA101YA0400Medicare PIN