MEDICARE: AMY MARIE PEREZ RN, BSN

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	163WG0000X	General Practice Registered Nurse	767701	CA

General Provider Information

NPI Number	:	1528904125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE PEREZ RN, BSN

Provider Business Mailing Address
First Line	:	27242 CALLE ALTA VIS
Second Line	:
City	:	CAPO BEACH
State	:	CA
Zip	:	92624-1050
Country	:	US
Telephone Number	:	909-223-9526
Fax Number	:

Provider Business Practice Location Address
First Line	:	27242 CALLE ALTA VIS
Second Line	:
City	:	CAPO BEACH
State	:	CA
Zip	:	92624-1050
Country	:	US
Telephone Number	:	909-223-9526
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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