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NPI Code Detail

MEDICARE: MARIO PEREZ

MEDICARE: MARIO PEREZ
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
1101Y00000XCounselor3039-RCA

General Provider Information

NPI Number : 1861702375
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIO PEREZ
Provider Business Mailing Address
First Line : 2501 W EL SEGUNDO BLVD
Second Line :
City : HAWTHORNE
State : CA
Zip : 90250-3317
Country : US
Telephone Number : 323-754-2816
Fax Number : 323-754-2828
Provider Business Practice Location Address
First Line : 2501 W EL SEGUNDO BLVD
Second Line :
City : HAWTHORNE
State : CA
Zip : 90250-3317
Country : US
Telephone Number : 323-754-2816
Fax Number : 323-754-2816
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2010
Last Update Date : 04/16/2026

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Directions to “ MARIO PEREZ ” Practice Location

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