Healthcare Provider Details

I. General information

NPI: 1083311013
Provider Name (Legal Business Name): OSVALDO JOEL SAMBOY PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 KUTZTOWN RD
READING PA
19605-1844
US

IV. Provider business mailing address

4343 12TH AVE
TEMPLE PA
19560-1643
US

V. Phone/Fax

Practice location:
  • Phone: 610-507-1977
  • Fax:
Mailing address:
  • Phone: 610-741-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW136294
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: