Healthcare Provider Details

I. General information

NPI: 1730528688
Provider Name (Legal Business Name): STEVEN PEREZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N 18TH ST STE 300
PHOENIX AZ
85006-3759
US

IV. Provider business mailing address

4801 E WASHINGTON ST STE 200
PHOENIX AZ
85034-2019
US

V. Phone/Fax

Practice location:
  • Phone: 602-507-4457
  • Fax: 602-507-4459
Mailing address:
  • Phone: 602-797-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2291
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberR2291
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: