Provider Demographics
NPI:1811016074
Name:PEREZ, ANITA G (RAS I)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:G
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RAS I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 PETALUMA DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-1717
Mailing Address - Country:US
Mailing Address - Phone:209-558-7475
Mailing Address - Fax:
Practice Address - Street 1:1100 KANSAS AVE STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-1596
Practice Address - Country:US
Practice Address - Phone:209-558-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARIP0702211314101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)