Provider Demographics
NPI:1679610448
Name:PEREZ, SANDRA (BA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6951 CASWELL LN
Mailing Address - Street 2:6951 CASWELL LN.
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1442
Mailing Address - Country:US
Mailing Address - Phone:714-336-5208
Mailing Address - Fax:
Practice Address - Street 1:6951 CASWELL LN
Practice Address - Street 2:6951 CASWELL LN.
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1442
Practice Address - Country:US
Practice Address - Phone:714-336-5208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health