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General NPI Number Information
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NPI Number | 1942536586
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Entity Type | Organization
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Legal Business Name | JOSE IGNACIO PEREA INC
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Dates
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Enumeration Date | 11/02/2009
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 12300 WILSHIRE BLVD. STE#404
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City | LOS ANGELES
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State | CA
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Zip | 90025-0000
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Country | US
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Telephone | 310-207-2272
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Fax | 310-207-2273
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Provider Business Mailing Address
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Address Line | 12300 WILSHIRE BLVD. STE# 404
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-207-2272
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE PEREA
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Credential |
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Telephone | 310-207-2272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48537
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License Number State | CA
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