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General NPI Number Information
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NPI Number | 1093055675
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Entity Type | Organization
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Legal Business Name | JORGE PEREZ MD LTD
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 1154 EMERALD BAY RD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6288
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Country | US
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Telephone | 775-883-3336
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Fax | 775-883-3336
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Provider Business Mailing Address
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Address Line | 1801 W OLYMPIC BLVD # 1359
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City | PASADENA
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State | CA
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Zip | 91199-0001
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Country | US
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Telephone | 775-883-3336
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Fax | 775-883-0877
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE PEREZ
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Credential | MD
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Telephone | 775-883-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | C52554
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License Number State | CA
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