Healthcare Provider Details

I. General information

NPI: 1821707456
Provider Name (Legal Business Name): JESSICA M PEREA ALONSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S. MADERA AVE. STE 302, 403 & 404
KERMAN CA
93630
US

IV. Provider business mailing address

275 S. MADERA AVE. STE 302, 403 & 404
KERMAN CA
93630
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax:
Mailing address:
  • Phone: 855-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW139844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: