Provider Demographics
NPI:1316291446
Name:PEREZ, SOFIA (BA)
Entity type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4604
Mailing Address - Country:US
Mailing Address - Phone:209-726-3090
Mailing Address - Fax:209-722-7648
Practice Address - Street 1:885 W 18TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4604
Practice Address - Country:US
Practice Address - Phone:209-726-3090
Practice Address - Fax:209-722-7648
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator