MEDICARE: JORGE PEREZ MD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	C52554	CA

General Provider Information

NPI Number	:	1093055675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORGE PEREZ MD LTD

Provider Business Mailing Address
First Line	:	1801 W OLYMPIC BLVD # 1359
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91199-0001
Country	:	US
Telephone Number	:	775-883-3336
Fax Number	:	775-883-0877

Provider Business Practice Location Address
First Line	:	1154 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6288
Country	:	US
Telephone Number	:	775-883-3336
Fax Number	:	775-883-3336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JORGE PEREZ
Credential	:	MD
Telephone Number	:	775-883-3336

Provider Enumeration Date	:	02/19/2013
Last Update Date	:	02/19/2013

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