MEDICARE: GLORIA S PEREZ LVN

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	164X00000X	Licensed Vocational Nurse	696797	CA

General Provider Information

NPI Number	:	1457957128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA S PEREZ LVN

Provider Business Mailing Address
First Line	:	1967 BANDONI AVE
Second Line	:
City	:	SAN LORENZO
State	:	CA
Zip	:	94580-2109
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2460 22ND ST # W94
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-2815
Country	:	US
Telephone Number	:	628-206-8524
Fax Number	:

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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