Provider Demographics
NPI:1215923271
Name:PEREZ, RODOLFO (MD)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:279 IMPERIAL HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1041
Mailing Address - Country:US
Mailing Address - Phone:714-449-4842
Mailing Address - Fax:714-449-4816
Practice Address - Street 1:500 W CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3027
Practice Address - Country:US
Practice Address - Phone:714-671-0768
Practice Address - Fax:714-257-6132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA43007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE85728Medicare UPIN