Healthcare Provider Details

I. General information

NPI: 1477132314
Provider Name (Legal Business Name): ALEJANDRO RAFAEL PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON STREET GME OFFICE WESTERLY SUITE 'C'
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

34045 THISTLEWOOD AVE
MURRIETA CA
92563-7489
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4085
  • Fax:
Mailing address:
  • Phone: 908-251-0791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number183054
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number183054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: