Provider Demographics
NPI:1255563235
Name:PEREA, OMAR A (MA)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:A
Last Name:PEREA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 MAPLEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2629
Mailing Address - Country:US
Mailing Address - Phone:719-651-9788
Mailing Address - Fax:
Practice Address - Street 1:1051 MAPLEWOOD WAY
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041-2629
Practice Address - Country:US
Practice Address - Phone:719-651-9788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist