MEDICARE: YESENIA D 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	LCSW93993	CA

General Provider Information

NPI Number	:	1215387139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YESENIA D PEREZ LCSW

Provider Business Mailing Address
First Line	:	3705 W PICO BLVD # 487
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	805-260-4825
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 W PICO BLVD # 487
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	805-260-4825
Fax Number	:	805-487-2599

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

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	09/18/2024

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