Provider Demographics
NPI:1871698258
Name:PEREZ, RAYMOND F (MS, MFT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:F
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 W DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2015
Mailing Address - Country:US
Mailing Address - Phone:714-480-6650
Mailing Address - Fax:714-571-5659
Practice Address - Street 1:1028 W DOROTHY DR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-2015
Practice Address - Country:US
Practice Address - Phone:714-480-6650
Practice Address - Fax:714-571-5659
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF40584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist