MEDICARE: DR. ANNARUTH PEREZ II D.D.S

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
1	1223G0001X	General Practice Dentistry	41982	CA

General Provider Information

NPI Number	:	1285765669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNARUTH PEREZ II D.D.S

Provider Business Mailing Address
First Line	:	13950 BADGER AVE
Second Line	:
City	:	SYLMAR
State	:	CA
Zip	:	91342-1872
Country	:	US
Telephone Number	:	818-367-7322
Fax Number	:	213-483-0001

Provider Business Practice Location Address
First Line	:	2161 W 6TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3121
Country	:	US
Telephone Number	:	213-483-8222
Fax Number	:	213-483-0001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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