Provider Demographics
NPI:1467542993
Name:PEREZ, CRISTINA (LISAC)
Entity Type:Individual
Prefix:MS
First Name:CRISTINA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2929
Mailing Address - Country:US
Mailing Address - Phone:026-685-6000
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:1111 S STAPLEY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5059
Practice Address - Country:US
Practice Address - Phone:026-685-6000
Practice Address - Fax:480-834-5703
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11723101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)