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General NPI Number Information
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NPI Number | 1811350861
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Entity Type | Individual
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Provider Name | EDGAR LUIS PEREZ
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Gender | Male
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | CALIFORNIA CENTER FOR NEUROINTERVENTIONAL SURGERY 11999 SORRENTO VALLEY ROAD, SUITE 203
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City | SAN DIEGO
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State | CA
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Zip | 92121
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Country | US
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Telephone | 714-856-5472
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Fax |
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Provider Business Mailing Address
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Address Line | 11120 E OCEAN AIR DR # 101-25
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City | SAN DIEGO
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State | CA
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Zip | 92130-4683
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Country | US
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Telephone | 773-428-3402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A173150
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | A173150
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License Number State | CA
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