Healthcare Provider Details

I. General information

NPI: 1518324151
Provider Name (Legal Business Name): CRISTIAN ADRIAN PEREZ LATORRE SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 VAN NUYS BLVD.
VAN NUYS CA
91401
US

IV. Provider business mailing address

9400 CORBIN AVENUE APT. 1095
NORTHRIDGE CA
91324
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-9090
  • Fax: 714-375-3889
Mailing address:
  • Phone: 818-660-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number14-646
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1601474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: