Healthcare Provider Details

I. General information

NPI: 1164346110
Provider Name (Legal Business Name): JAIME PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5637 VIA ESCALANTE
RIVERSIDE CA
92509-5574
US

IV. Provider business mailing address

5637 VIA ESCALANTE
RIVERSIDE CA
92509-5574
US

V. Phone/Fax

Practice location:
  • Phone: 714-454-2866
  • Fax:
Mailing address:
  • Phone: 714-454-2866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: