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General NPI Number Information
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NPI Number | 1871705376
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Entity Type | Organization
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Legal Business Name | JOSE LUIS PEREZ MD INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3000 E 1ST STREEST
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City | LOS ANGELES
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State | CA
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Zip | 90063
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Country | US
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Telephone | 818-281-8312
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Fax |
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Provider Business Mailing Address
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Address Line | 4839 N BONNIE COVE AVE
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City | COVINA
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State | CA
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Zip | 91724
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Country | US
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Telephone | 818-281-8312
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE LUIS PEREZ
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Credential | MD
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Telephone | 818-281-8312
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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 | A74744
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License Number State | CA
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