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General NPI Number Information
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NPI Number | 1558717686
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Entity Type | Organization
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Legal Business Name | MIGUEL G. DE PERIO M.D. INC.
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Dates
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Enumeration Date | 05/07/2016
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Last Update Date | 05/07/2016
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Provider Practice Location Address
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Address Line | 14476 ALDER DR
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City | CORONA
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State | CA
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Zip | 92880-3517
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Country | US
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Telephone | 949-463-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 14476 ALDER DR
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City | CORONA
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State | CA
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Zip | 92880-3517
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Country | US
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Telephone | 949-463-4004
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MIGUEL G DE PERIO
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Credential |
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Telephone | 949-463-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A43710
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License Number State | CA
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