Individual
ANDREA GUADALUPE PEREZ PORTILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1375 SYCAMORE AVE APT 211, HERCULES, CA 94547-5519
(510) 253-5199
Mailing address
1375 SYCAMORE AVE APT 211, HERCULES, CA 94547-5519
(510) 253-5199
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
74204
CA
104100000X
Social Worker
74204
CA
1041C0700X
Clinical Social Worker
Primary
96134
CA
390200000X
Student in an Organized Health Care Education/Training Program
74204
CA
Other
Enumeration date
08/22/2016
Last updated
02/20/2024
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