Provider Demographics
NPI:1053869974
Name:PEREZ, MARIA ELENA (MA,MFT, RN, BSN)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ELENA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MA,MFT, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 I STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-835-4969
Mailing Address - Fax:916-473-7147
Practice Address - Street 1:2701 I STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-835-4969
Practice Address - Fax:916-473-7247
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372403163W00000X
CA110585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty