Healthcare Provider Details

I. General information

NPI: 1821724915
Provider Name (Legal Business Name): JASMINE PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 VISTA WAY
OCEANSIDE CA
92056-4565
US

IV. Provider business mailing address

3020 CHILDRENS WAY # MC5170
SAN DIEGO CA
92123-4223
US

V. Phone/Fax

Practice location:
  • Phone: 760-547-1010
  • Fax:
Mailing address:
  • Phone: 858-576-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW113221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: