Active NPI
Elizabeth Perez
- Clinical Social Worker
- Modesto, CA
National Provider Identifier
1710356852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 108170
- Practice address
- 1620 Cummins Dr
Modesto, CA 95358-6400 - Phone
- (209) 576-1750
- Fax
- (209) 576-1768
- NPI assigned
- Sep 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Clinical Social Worker | 1041C0700X | 108170 | CA | Primary |
Addresses
Primary practice location
1620 Cummins Dr
Modesto, CA 95358-6400
Mailing address
2020 Sherwood PL
Manteca, CA 95336-6316
Phone (209) 482-4147
Other practice location 1
2020 Sherwood Pl
Manteca, CA 95336-6316
Phone (209) 482-4147
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 108170 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1442534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1710356852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2020 SHERWOOD PL",
"city": "MANTECA",
"state": "CA",
"postal_code": "953366316",
"telephone_number": "209-482-4147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1620 CUMMINS DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953586400",
"telephone_number": "209-576-1750",
"fax_number": "209-576-1768"
}
],
"practiceLocations": [
{
"address_1": "2020 Sherwood Pl",
"address_purpose": "LOCATION",
"city": "Manteca",
"state": "CA",
"postal_code": "953366316",
"country_code": "US",
"telephone_number": "209-482-4147",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREZ",
"first_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-18",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "108170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.