MEDICARE: DIANA L PEREZ-JOHNSON 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	23254	CA

General Provider Information

NPI Number	:	1407920903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA L PEREZ-JOHNSON LCSW

Provider Business Mailing Address
First Line	:	4341 FALCON AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2502
Country	:	US
Telephone Number	:	562-900-7103
Fax Number	:

Provider Business Practice Location Address
First Line	:	2629 CLARENDON AVE
Second Line	:	2ND FL.
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4119
Country	:	US
Telephone Number	:	323-584-3700
Fax Number	:	323-277-4674

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	09/03/2014

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