Provider Demographics
NPI:1104949288
Name:PEREZ, ANTONIA (RRW)
Entity type:Individual
Prefix:MS
First Name:ANTONIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 L ST APT A9
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1121
Mailing Address - Country:US
Mailing Address - Phone:619-476-7067
Mailing Address - Fax:
Practice Address - Street 1:580 L ST APT A9
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1121
Practice Address - Country:US
Practice Address - Phone:619-476-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37-09101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)