MEDICARE: JOSE A PEREZ MD

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	207Q00000X	Family Medicine Physician	A20957	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225229636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE A PEREZ MD

Provider Business Mailing Address
First Line	:	3521 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1709
Country	:	US
Telephone Number	:	323-604-0260
Fax Number	:	323-604-0263

Provider Business Practice Location Address
First Line	:	3521 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1709
Country	:	US
Telephone Number	:	323-604-0260
Fax Number	:	323-604-0263

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE A PEREZ
Credential	:	MD
Telephone Number	:	323-604-0260

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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