Basic Information
| Provider Information | |||||||||
| NPI: | 1194856229 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ADEF | ||||||||
| FirstName: | PERLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 S OAK KNOLL AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267956907 | ||||||||
| FaxNumber: | 6267957080 | ||||||||
| Practice Location | |||||||||
| Address1: | 118 S OAK KNOLL AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267956907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF67364 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.