Healthcare Provider Details

I. General information

NPI: 1609285477
Provider Name (Legal Business Name): ANA CRISTINA PEREZ RODRIGUEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8611
  • Fax: 562-933-7802
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: