Healthcare Provider Details

I. General information

NPI: 1740620079
Provider Name (Legal Business Name): KATHLEEN PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ODYSSEY STE 255
IRVINE CA
92618-7701
US

IV. Provider business mailing address

22 ODYSSEY STE 255
IRVINE CA
92618-7701
US

V. Phone/Fax

Practice location:
  • Phone: 949-600-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA140684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: