Healthcare Provider Details

I. General information

NPI: 1285664664
Provider Name (Legal Business Name): JOHN M PERIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE STE 202
BURBANK CA
91505-4406
US

IV. Provider business mailing address

2701 W ALAMEDA AVE STE 202
BURBANK CA
91505-4406
US

V. Phone/Fax

Practice location:
  • Phone: 818-570-0542
  • Fax: 818-558-1156
Mailing address:
  • Phone: 818-570-0542
  • Fax: 818-558-1156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA79419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: