Provider Demographics
NPI:1801642699
Name:PEREZ, MARCO ALLEN (APCC)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ALLEN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 CAMINO DEL RIO N STE 305
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1632
Mailing Address - Country:US
Mailing Address - Phone:619-363-1920
Mailing Address - Fax:
Practice Address - Street 1:2650 CAMINO DEL RIO N STE 305
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1632
Practice Address - Country:US
Practice Address - Phone:619-363-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health