Organization Name: | MARK PEREZ , M.D. |
NPI Number: | 1255639522 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIA E BAEZ (CEO) |
Mailing Address: | 1366 W 7th St Suite 4-b San Pedro |
State: | CA US |
Postal Code: | 907323500 |
Phone Number: | 3105472197 |
Fax Number: | |
NPI Enumeration Date: | 03/10/2011 |
NPI Last Update Date: | 03/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G67514 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |