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NPI Code Detail

MEDICARE: VIRGIL JOSEPH PEDRO L.C.S.W.

MEDICARE: VIRGIL JOSEPH PEDRO L.C.S.W.
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
11041C0700XClinical Social WorkerLCSW-1934AZ

General Provider Information

NPI Number : 1962781294
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGIL JOSEPH PEDRO L.C.S.W.
Provider Business Mailing Address
First Line : 9010 MAGNOLIA AVENUE
Second Line : SHERMAN INDIAN HIGH SCHOOL
City : RIVERSIDE
State : CA
Zip : 92503-4431
Country : US
Telephone Number : 951-509-8780
Fax Number : 951-509-8933
Provider Business Practice Location Address
First Line : 9010 MAGNOLIA AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-4431
Country : US
Telephone Number : 951-509-8780
Fax Number : 951-509-8933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2011
Last Update Date : 08/04/2011

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Directions to “ VIRGIL JOSEPH PEDRO L.C.S.W.” Practice Location

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