MEDICARE: MELISSA ROSE PEREZ MSW

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	ASW28611	CA
2	390200000X	Student in an Organized Health Care Education/Training Program		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497937551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ROSE PEREZ MSW

Provider Business Mailing Address
First Line	:	2801 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2709
Country	:	US
Telephone Number	:	858-694-4680
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 MEADOW LARK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2709
Country	:	US
Telephone Number	:	858-694-4680
Fax Number	:

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

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	07/26/2018

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