Healthcare Provider Details

I. General information

NPI: 1497828388
Provider Name (Legal Business Name): SUSIE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

21127 BRIGHTON AVE
TORRANCE CA
90501-2314
US

V. Phone/Fax

Practice location:
  • Phone: 424-306-7213
  • Fax:
Mailing address:
  • Phone: 310-347-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number581067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number16157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: