=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902804370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUZ PEREZ-SCHWARTZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 07/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3551 N BROAD ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-430-4022
-----------------------------------------------------
Fax | 215-430-4079
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | SHRINERS HOSPITAL FOR CHILDREN PHILADELPHIA LOCKBOX #7642
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19178-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-281-8478
-----------------------------------------------------
Fax | 813-281-8113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD048347L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------