Provider Demographics
NPI:1396799185
Name:PEREZ, JOSE M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:PEREZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2029 VERDUGO BLVD # 120
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1626
Mailing Address - Country:US
Mailing Address - Phone:818-900-2063
Mailing Address - Fax:818-296-1074
Practice Address - Street 1:1111 FOOTHILL BLVD STE C
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3207
Practice Address - Country:US
Practice Address - Phone:818-900-2063
Practice Address - Fax:818-296-1074
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-09-09
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Provider Licenses
StateLicense IDTaxonomies
CAA88799208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49048Medicare UPIN