MEDICARE: MARCELA I. PEREZ, D.D.S., INC.

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	1223G0001X	General Practice Dentistry	32163	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9200301	OTHER	CA	DENTI CAL

General Provider Information

NPI Number	:	1205090677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCELA I. PEREZ, D.D.S., INC.

Provider Business Mailing Address
First Line	:	6711 S. GREENLEAF AVENUE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4110
Country	:	US
Telephone Number	:	562-698-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	6711 GREENLEAF AVE
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90601-4110
Country	:	US
Telephone Number	:	562-698-0054
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARCELA I. PEREZ
Credential	:	D.D.S.
Telephone Number	:	562-698-0054

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	07/15/2008

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