MEDICARE: MRS. CHRISTINA PEREZ MSW

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

General Provider Information

NPI Number	:	1619528247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA PEREZ MSW

Provider Business Mailing Address
First Line	:	1912 N 201ST AVE
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85396-8707
Country	:	US
Telephone Number	:	623-225-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 E COTTON CENTER BLVD STE 250
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-4806
Country	:	US
Telephone Number	:	602-633-1828
Fax Number	:

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

Provider Enumeration Date	:	09/25/2019
Last Update Date	:	09/25/2019

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