Basic Information
| Provider Information | |||||||||
| NPI: | 1447578547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENDEZ | ||||||||
| FirstName: | IRMA | ||||||||
| MiddleName: | PEREZ | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | COUNSELOR ADDICTION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 SUNRISE AVE. SUITE310A ROSEVILLE CA. 95661 | ||||||||
| Address2: | 1530 THIRD STREET, SUITE 202 | ||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164348927 | ||||||||
| FaxNumber: | 9164340678 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 3RD ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956482501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164348927 | ||||||||
| FaxNumber: | 9164340678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 05/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 31-001-04-120 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.