MEDICARE: IRENE PERALES

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	63318	TX

General Provider Information

NPI Number	:	1457101370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE PERALES

Provider Business Mailing Address
First Line	:	332 BEAR RIDGE DR
Second Line	:
City	:	LA VERNIA
State	:	TX
Zip	:	78121-9526
Country	:	US
Telephone Number	:	210-392-7960
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 BEAR RIDGE DR
Second Line	:
City	:	LA VERNIA
State	:	TX
Zip	:	78121-9526
Country	:	US
Telephone Number	:	210-392-7960
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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