Organization Name: | LUIS A PEREZ MD INC |
NPI Number: | 1184934648 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LUIS A PEREZ (PRESIDENT/CEO) |
Mailing Address: | 1220 S Central Ave Ste 102 Glendale |
State: | CA US |
Postal Code: | 912043805 |
Phone Number: | 8183960074 |
Fax Number: | 8183960075 |
NPI Enumeration Date: | 10/18/2010 |
NPI Last Update Date: | 10/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A56266 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |