MEDICARE: LINDA JOCELYN MACIAS PEREZ

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	103TC1900X	Counseling Psychologist
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1437962289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JOCELYN MACIAS PEREZ

Provider Business Mailing Address
First Line	:	1253 S TOWNSEND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3326
Country	:	US
Telephone Number	:	213-443-6374
Fax Number	:

Provider Business Practice Location Address
First Line	:	6532 PACIFIC BLVD # C
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4106
Country	:	US
Telephone Number	:	323-588-5971
Fax Number	:

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

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	12/22/2025

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