=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720116635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. ALFREDO TRINIDAD PEREZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 03/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13710 STUDEBAKER RD UNIT F 100
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90650-9065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-933-3585
-----------------------------------------------------
Fax | 562-925-6552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3025 ARTESIA BLVD UNIT 157
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90504-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-347-2078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 39063
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------