Provider Demographics
NPI:1629322102
Name:PEREZ, ANNA L (RAS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4459 VOLTAIRE DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7309
Mailing Address - Country:US
Mailing Address - Phone:530-409-2067
Mailing Address - Fax:
Practice Address - Street 1:4459 VOLTAIRE DRIVE
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7309
Practice Address - Country:US
Practice Address - Phone:530-676-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9425358203245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215072293OtherPROGRESS HOUSE INC.