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NPI Code Detail

MEDICARE: EMILY M PEREZ RADT 1

MEDICARE: EMILY M PEREZ RADT 1
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorR1321030818CA

General Provider Information

NPI Number : 1235699950
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY M PEREZ RADT 1
Provider Business Mailing Address
First Line : 303 E 52ND ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-4513
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 303 E 52ND ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90011-4513
Country : US
Telephone Number : 323-918-2139
Fax Number : 323-676-5239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 05/20/2021

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