MEDICARE: MS. SANDRA LYNN PEREZ NP

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	363L00000X	Nurse Practitioner	313381	CA

General Provider Information

NPI Number	:	1396728044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA LYNN PEREZ NP

Provider Business Mailing Address
First Line	:	344 GARCIA AVE
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1851
Country	:	US
Telephone Number	:	415-750-2115
Fax Number	:	415-750-2181

Provider Business Practice Location Address
First Line	:	344 GARCIA AVE
Second Line	:
City	:	HALF MOON BAY
State	:	CA
Zip	:	94019-1851
Country	:	US
Telephone Number	:	415-750-2115
Fax Number	:	415-750-2181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/01/2012

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