Healthcare Provider Details

I. General information

NPI: 1770862856
Provider Name (Legal Business Name): JOHN M. PERIC MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 403
BURBANK CA
91505-4402
US

IV. Provider business mailing address

11333 MOORPARK ST #188
STUDIO CITY CA
91602-2618
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 Number
License Number StateCA

VIII. Authorized Official

Name: JOHN MARIO PERIC
Title or Position: MD, OWNER
Credential: MD
Phone: 818-570-0542