MEDICARE: MICHELLE PEREIRA

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
2	1041C0700X	Clinical Social Worker	99631	CA

General Provider Information

NPI Number	:	1457786451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PEREIRA

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-301-8771
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 UCLA MEDICAL PLZ STE 1100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-2531
Country	:	US
Telephone Number	:	310-825-9989
Fax Number	:

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

Provider Enumeration Date	:	09/09/2013
Last Update Date	:	11/10/2022

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Directions to “ MICHELLE PEREIRA ” Practice Location

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