Provider Demographics
NPI:1831338144
Name:MARTIN A PEREZ PHD AND ASSOCIATES A PROFESSIONAL CLINICAL PSYCHOLOGY
Entity type:Organization
Organization Name:MARTIN A PEREZ PHD AND ASSOCIATES A PROFESSIONAL CLINICAL PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-806-6857
Mailing Address - Street 1:107 S FAIR OAKS AVE
Mailing Address - Street 2:SUITE # 315
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2010
Mailing Address - Country:US
Mailing Address - Phone:626-806-6857
Mailing Address - Fax:626-744-0677
Practice Address - Street 1:107 S FAIR OAKS AVE
Practice Address - Street 2:SUITE # 315
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2010
Practice Address - Country:US
Practice Address - Phone:626-806-6857
Practice Address - Fax:626-744-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851462469OtherNPI TYPE 1
CACP18155Medicare PIN