Provider Demographics
NPI:1821528001
Name:PEREZ, VICKY CELINA (BA)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:CELINA
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 1:3815 MING AVE # 238
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5052
Mailing Address - Country:US
Mailing Address - Phone:661-868-8310
Mailing Address - Fax:
Practice Address - Street 1:3300 TRUXTUN AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3123
Practice Address - Country:US
Practice Address - Phone:661-845-5100
Practice Address - Fax:661-845-5106
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA119761104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker