Healthcare Provider Details

I. General information

NPI: 1891624060
Provider Name (Legal Business Name): RICARDO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4399 LEVELSIDE AVE
LAKEWOOD CA
90712-3752
US

IV. Provider business mailing address

4399 LEVELSIDE AVE
LAKEWOOD CA
90712-3752
US

V. Phone/Fax

Practice location:
  • Phone: 562-256-6152
  • Fax:
Mailing address:
  • Phone: 562-587-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number030451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: