Provider Demographics
NPI:1457651853
Name:PEREZ, MONIQUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name: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 1:1144 LITA LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7235
Mailing Address - Country:US
Mailing Address - Phone:760-216-8921
Mailing Address - Fax:760-643-1406
Practice Address - Street 1:440 S MELROSE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6666
Practice Address - Country:US
Practice Address - Phone:760-216-8921
Practice Address - Fax:760-643-1406
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist