Provider Demographics
NPI:1912630294
Name:PEREZ, AVIANNA C (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:AVIANNA
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:ODESSA
Other - Middle Name:AVIANNA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, AMFT
Mailing Address - Street 1:3570 HERMAN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-4240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3570 HERMAN AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4240
Practice Address - Country:US
Practice Address - Phone:510-858-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist