Provider Demographics
NPI:1982030425
Name:PEREZ, JULIA (MFT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 LONETREE BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5874
Mailing Address - Country:US
Mailing Address - Phone:916-672-1198
Mailing Address - Fax:
Practice Address - Street 1:6520 LONETREE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5874
Practice Address - Country:US
Practice Address - Phone:916-672-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13681061OtherCAQH