Provider Demographics
NPI:1588140891
Name:PEREZ, KRISTIE COMBS
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:COMBS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:LEE
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:591 CAMINO DE LA REINA STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1880 CAMINO DE LA REINA PARK
Practice Address - Street 2:1077
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-567-0221
Practice Address - Fax:619-914-1200
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA999831041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health