Basic Information
| Provider Information | |||||||||
| NPI: | 1871698258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS, MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1028 W DOROTHY DR | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928212015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806650 | ||||||||
| FaxNumber: | 7145715659 | ||||||||
| Practice Location | |||||||||
| Address1: | 1028 W DOROTHY DR | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928212015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144806650 | ||||||||
| FaxNumber: | 7145715659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF40584 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.