MEDICARE: BERENICE PEREZ ACSW

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	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	101YM0800X	Mental Health Counselor	83481	CA
3	1041C0700X	Clinical Social Worker	105005	CA

General Provider Information

NPI Number	:	1083133953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERENICE PEREZ ACSW

Provider Business Mailing Address
First Line	:	2008 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-2722
Country	:	US
Telephone Number	:	909-242-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 N GAREY AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767
Country	:	US
Telephone Number	:	909-242-7640
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	12/15/2025

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