Provider Demographics
NPI:1528401965
Name:PEREZ, REBECCA REYNA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:REYNA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 FALLON RD # 224
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7400
Mailing Address - Country:US
Mailing Address - Phone:510-686-3494
Mailing Address - Fax:
Practice Address - Street 1:3420 FINNIAN WAY UNIT 226
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4588
Practice Address - Country:US
Practice Address - Phone:510-686-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist