Healthcare Provider Details

I. General information

NPI: 1851949580
Provider Name (Legal Business Name): MICHAEL PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1000 S GRAND AVE APT 429
LOS ANGELES CA
90015-3473
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-9088
  • Fax:
Mailing address:
  • Phone: 323-409-4088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number687903
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95028266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: