Provider Demographics
NPI:1700943776
Name:PEREZ, ROBERT GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GEORGE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1777 HAMILTON AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5430
Mailing Address - Country:US
Mailing Address - Phone:408-266-5800
Mailing Address - Fax:408-266-5809
Practice Address - Street 1:1777 HAMILTON AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5430
Practice Address - Country:US
Practice Address - Phone:408-266-5800
Practice Address - Fax:408-266-5809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY8125103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL81250Medicare ID - Type UnspecifiedPSYCHOLOGIST