Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3976 | AZ |
Y | 103T00000X | Psychologist | 3976 | AZ |
N | 103TS0200X | School Psychologist | 3976 | AZ |
NPI | 1104071471 |
---|---|
Provider Name | Dr. Gustavo Joaquin Perez |
First Address | Tucson, AZ 85711-2629 |
Second Address | Tucson, AZ 85711-2629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2008 |
Last Update Date | 17/03/2018 |