Provider Demographics
NPI:1326885542
Name:PEREZ, VANESSA (CCMA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 E HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-3717
Mailing Address - Country:US
Mailing Address - Phone:221-045-4646
Mailing Address - Fax:
Practice Address - Street 1:1833 E HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-3717
Practice Address - Country:US
Practice Address - Phone:210-454-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician