Individual
MICAH REUBEN CHARLES PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
867 N FAIR OAKS AVE, PASADENA, CA 91103-3050
(626) 993-3165
Mailing address
867 N FAIR OAKS AVE, PASADENA, CA 91103-3050
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
18057
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/02/2020
Last updated
12/13/2024
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