Healthcare Provider Details

I. General information

NPI: 1801658109
Provider Name (Legal Business Name): CEASAR J PEREZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72780 COUNTRY CLUB DR STE 203
RANCHO MIRAGE CA
92270-4150
US

IV. Provider business mailing address

455 PEREGRINE LN
SAN JACINTO CA
92582-2718
US

V. Phone/Fax

Practice location:
  • Phone: 760-834-3593
  • Fax: 760-674-3845
Mailing address:
  • Phone: 951-992-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: