Provider Demographics
NPI:1487033296
Name:PEREZ, ROY I
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:PEREZ
Suffix:I
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 1:350 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1112
Mailing Address - Country:US
Mailing Address - Phone:415-971-3034
Mailing Address - Fax:
Practice Address - Street 1:350 JENNIFER DR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1112
Practice Address - Country:US
Practice Address - Phone:415-971-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor