Healthcare Provider Details

I. General information

NPI: 1891376406
Provider Name (Legal Business Name): JM PERIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
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 Number
License Number State

VIII. Authorized Official

Name: JOHN M PERIC
Title or Position: OWNER
Credential: MD
Phone: 818-984-7055