Basic Information
| Provider Information | |||||||||
| NPI: | 1629487426 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOVAR PEREZ | ||||||||
| FirstName: | SELENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2625 ZANKER RD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951342130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4084680100 | ||||||||
| FaxNumber: | 4084326225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3490 THE ALAMEDA | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950504333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082430222 | ||||||||
| FaxNumber: | 4082891140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2014 | ||||||||
| LastUpdateDate: | 05/02/2016 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.