Healthcare Provider Details

I. General information

NPI: 1811350861
Provider Name (Legal Business Name): EDGAR LUIS PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 06/10/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALIFORNIA CENTER FOR NEUROINTERVENTIONAL SURGERY 11999 SORRENTO VALLEY ROAD, SUITE 203
SAN DIEGO CA
92121
US

IV. Provider business mailing address

11120 E OCEAN AIR DR # 101-25
SAN DIEGO CA
92130-4683
US

V. Phone/Fax

Practice location:
  • Phone: 714-856-5472
  • Fax:
Mailing address:
  • Phone: 773-428-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA173150
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA173150
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: