Provider Demographics
NPI:1285117671
Name:LOERA, ESTEFANIE PEREZ
Entity type:Individual
Prefix:
First Name:ESTEFANIE
Middle Name:PEREZ
Last Name:LOERA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ESTEFANIE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13735 RICHARD WAY APT A
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-5917
Mailing Address - Country:US
Mailing Address - Phone:760-676-7970
Mailing Address - Fax:
Practice Address - Street 1:14320 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6874
Practice Address - Country:US
Practice Address - Phone:760-393-3443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 174400000X
CA112422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty