Provider Demographics
NPI:1639115660
Name:PEREZ, JACQUELINE ANDREA (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANDREA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 ADDISON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1140
Mailing Address - Country:US
Mailing Address - Phone:510-644-8031
Mailing Address - Fax:510-644-8036
Practice Address - Street 1:2030 ADDISON ST STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1140
Practice Address - Country:US
Practice Address - Phone:510-644-8031
Practice Address - Fax:510-644-8036
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist