Provider Demographics
NPI:1093385916
Name:PEREZ, ANGELA (LMT, CMT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 AVIATION BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1074
Mailing Address - Country:US
Mailing Address - Phone:707-541-6258
Mailing Address - Fax:
Practice Address - Street 1:418 AVIATION BLVD STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1074
Practice Address - Country:US
Practice Address - Phone:707-541-6258
Practice Address - Fax:707-284-0122
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator