Provider Demographics
NPI:1730894957
Name:PEREZ, JAMIE IVAN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:IVAN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 S MERIDIAN APT M202
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1486
Mailing Address - Country:US
Mailing Address - Phone:559-907-4443
Mailing Address - Fax:
Practice Address - Street 1:2923 S MERIDIAN APT M202
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1486
Practice Address - Country:US
Practice Address - Phone:559-907-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)