Healthcare Provider Details

I. General information

NPI: 1861446890
Provider Name (Legal Business Name): KATHERINE KIYOMI PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD GLASSROCK BLDG
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2516 STOCKTON BLVD TICON II,
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2781
  • Fax: 916-734-1357
Mailing address:
  • Phone: 916-734-2781
  • Fax: 916-451-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG074591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: