Provider Demographics
NPI:1386924504
Name:PEREZ MOODY, VANESSA G (MD)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:G
Last Name:PEREZ MOODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:G
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD
Mailing Address - Street 2:MS 76
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-669-2113
Mailing Address - Fax:323-361-8003
Practice Address - Street 1:4650 W SUNSET BLVD
Practice Address - Street 2:MS 76
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-669-2113
Practice Address - Fax:323-361-8003
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics