Provider Demographics
NPI:1457840282
Name:PEREA, ADRIANA PATRICIA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:PATRICIA
Last Name:PEREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 W AVENUE 136TH APT B
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4154
Mailing Address - Country:US
Mailing Address - Phone:510-514-6837
Mailing Address - Fax:
Practice Address - Street 1:1249 PINOLE VALLEY RD STE 201
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1383
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-60679103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst