Basic Information
| Provider Information | |||||||||
| NPI: | 1629475140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | CASILDO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20354 HAVILAND AVE | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945411966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109878160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 FRANKLIN ST | ||||||||
| Address2: | 6221 GEARY STREET | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154747310 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2014 | ||||||||
| LastUpdateDate: | 12/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.