MEDICARE: ROSA OFELIA PEREZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	29341	CA

General Provider Information

NPI Number	:	1053532374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA OFELIA PEREZ LCSW

Provider Business Mailing Address
First Line	:	5441 E MADISON AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93727-3325
Country	:	US
Telephone Number	:	559-940-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST STE 112
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6818
Country	:	US
Telephone Number	:	855-343-1057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	08/26/2024

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