Provider Demographics
NPI:1831216779
Name:PEREZ, ROBIN LOUIS (PMHNP)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:LOUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 NW 2ND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3517
Mailing Address - Country:US
Mailing Address - Phone:503-266-1407
Mailing Address - Fax:503-266-1849
Practice Address - Street 1:409 NW 2ND AVE STE B
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3517
Practice Address - Country:US
Practice Address - Phone:503-266-1407
Practice Address - Fax:503-266-1849
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150158NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR731642750OtherTAX IDENTIFICATION NUMBER
OR500668332Medicaid