Provider Demographics
NPI:1669881009
Name:PEREZ, NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1080
Mailing Address - Country:US
Mailing Address - Phone:415-422-2725
Mailing Address - Fax:
Practice Address - Street 1:2130 FULTON ST
Practice Address - Street 2:UNIVERSITY OF SAN FRANCISCO-ATHLETICS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1080
Practice Address - Country:US
Practice Address - Phone:415-422-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer