Healthcare Provider Details

I. General information

NPI: 1942860655
Provider Name (Legal Business Name): VICTOR E. PEREZ F.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COCHIMIES 5513-A COL. HERRERA
TIJUANA BAJA CALIFORNIA
22534
MX

IV. Provider business mailing address

641 E SAN YSIDRO BLVD. SUITE #B3-1654
SAN YSIDRO CA
92173
US

V. Phone/Fax

Practice location:
  • Phone: 664-477-0606
  • Fax: 619-349-6409
Mailing address:
  • Phone: 664-477-0606
  • Fax: 619-349-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR EMILIO PEREZ F.
Title or Position: OWNER
Credential: DDS
Phone: 664-477-0606