Provider Demographics
NPI:1336290691
Name:PEREZ, JOSE L (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3629
Mailing Address - Country:US
Mailing Address - Phone:323-908-4200
Mailing Address - Fax:
Practice Address - Street 1:4425 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3629
Practice Address - Country:US
Practice Address - Phone:323-908-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74744208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74744Medicare ID - Type UnspecifiedLICENSE
CA122493Medicare UPIN
CAI22493Medicare UPIN