Healthcare Provider Details

I. General information

NPI: 1699866061
Provider Name (Legal Business Name): ROBERT G PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SULLIVAN AVE SUITE 507
DALLY CITY CA
94015
US

IV. Provider business mailing address

1800 SULLIVAN AVE SUITE 507
DALLY CITY CA
94015
US

V. Phone/Fax

Practice location:
  • Phone: 650-994-9936
  • Fax: 650-994-2016
Mailing address:
  • Phone: 650-994-9936
  • Fax: 650-994-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG58842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: