MEDICARE: WALTER ALEXIS PEREZ NP

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	363L00000X	Nurse Practitioner	95005174	CA

General Provider Information

NPI Number	:	1700336245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER ALEXIS PEREZ NP

Provider Business Mailing Address
First Line	:	5901 E 7TH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90822-5201
Country	:	US
Telephone Number	:	323-251-9327
Fax Number	:

Provider Business Practice Location Address
First Line	:	763 E 52ND ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-4031
Country	:	US
Telephone Number	:	323-251-9327
Fax Number	:

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

Provider Enumeration Date	:	10/07/2016
Last Update Date	:	01/07/2019

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