Provider Demographics
NPI:1790309664
Name:PEREZ-STABLE, OLGA M (MA)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:PEREZ-STABLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4720
Mailing Address - Country:US
Mailing Address - Phone:714-307-1229
Mailing Address - Fax:
Practice Address - Street 1:1956 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4720
Practice Address - Country:US
Practice Address - Phone:714-307-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM17033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist