MEDICARE: ROSANA ISABEL TRIVINO-PEREZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	26355	CA

General Provider Information

NPI Number	:	1356648976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSANA ISABEL TRIVINO-PEREZ LCSW

Provider Business Mailing Address
First Line	:	10940 WILSHIRE BLVD
Second Line	:	16TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3915
Country	:	US
Telephone Number	:	310-709-8892
Fax Number	:

Provider Business Practice Location Address
First Line	:	10940 WILSHIRE BLVD
Second Line	:	16TH FLOOR
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3915
Country	:	US
Telephone Number	:	310-709-8892
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2011
Last Update Date	:	02/16/2011

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