Provider Demographics
NPI:1053546655
Name:PEREZ, JODIE N (PSYD)
Entity type:Individual
Prefix:DR
First Name:JODIE
Middle Name:N
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JODIE
Other - Middle Name:N
Other - Last Name:STELZRIEDE-PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-8805
Mailing Address - Country:US
Mailing Address - Phone:925-381-7887
Mailing Address - Fax:
Practice Address - Street 1:7707 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-8312
Practice Address - Country:US
Practice Address - Phone:925-381-7887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29373103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty