MEDICARE: FRITZI A PEREZ-MYERS, DMD, INC.

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	122300000X	Dentist	39998	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B39998	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1841538303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRITZI A PEREZ-MYERS, DMD, INC.

Provider Business Mailing Address
First Line	:	PO BOX 262465
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92196-2465
Country	:	US
Telephone Number	:	858-586-9195
Fax Number	:	858-586-9198

Provider Business Practice Location Address
First Line	:	9750 MIRAMAR RD STE 160
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4561
Country	:	US
Telephone Number	:	858-586-9195
Fax Number	:	858-586-9198

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRITZI PEREZ-MYERS
Credential	:	DMD
Telephone Number	:	858-586-9195

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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