Healthcare Provider Details

I. General information

NPI: 1235868571
Provider Name (Legal Business Name): FIDEL M PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82013 DR CARREON BLVD STE M
INDIO CA
92201-5832
US

IV. Provider business mailing address

82013 DR CARREON BLVD STE M
INDIO CA
92201-5832
US

V. Phone/Fax

Practice location:
  • Phone: 760-262-0233
  • Fax:
Mailing address:
  • Phone: 760-262-0233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number198957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: