Healthcare Provider Details

I. General information

NPI: 1114053410
Provider Name (Legal Business Name): ALEXA JOY PEREZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXA CHRISTENSEN

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E GILBERT ST
SAN BERNARDINO CA
92415-1004
US

IV. Provider business mailing address

900 E GILBERT ST
SAN BERNARDINO CA
92415-1004
US

V. Phone/Fax

Practice location:
  • Phone: 909-386-0785
  • Fax: 909-386-0750
Mailing address:
  • Phone: 909-386-0785
  • Fax: 909-386-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 20866
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: