Provider Demographics
NPI:1306988423
Name:PEREZ, GRETA TERESA
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:TERESA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RYAN DR APT 16
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-5168
Mailing Address - Country:US
Mailing Address - Phone:925-825-7565
Mailing Address - Fax:925-427-8304
Practice Address - Street 1:600 RYAN DR APT 16
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-5168
Practice Address - Country:US
Practice Address - Phone:925-825-7565
Practice Address - Fax:925-427-8304
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine