Provider Demographics
NPI:1184890568
Name:PEREZ, VICENTE VAQUERA
Entity type:Individual
Prefix:
First Name:VICENTE
Middle Name:VAQUERA
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 LENZEN AVE
Mailing Address - Street 2:ROOM 1900
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2737
Mailing Address - Country:US
Mailing Address - Phone:408-792-5656
Mailing Address - Fax:408-947-8719
Practice Address - Street 1:976 LENZEN AVE
Practice Address - Street 2:ROOM 1900
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2737
Practice Address - Country:US
Practice Address - Phone:408-792-5656
Practice Address - Fax:408-947-8719
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)