Healthcare Provider Details

I. General information

NPI: 1548620404
Provider Name (Legal Business Name): MARI PEREZ-ROSENDAHL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BUILDING 1, 3RD FLOOR
ORANGE CA
92868
US

IV. Provider business mailing address

101 THE CITY DR S BUILDING 1, 3RD FLOOR
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-6141
  • Fax:
Mailing address:
  • Phone: 714-456-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberA141371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: