MEDICARE: FREDY PEREZ OD A PROFESSIONAL CORP

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	261Q00000X	Clinic/Center	6315T	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	:	1891995403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREDY PEREZ OD A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	1509 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3319
Country	:	US
Telephone Number	:	213-250-5768
Fax Number	:	213-250-5773

Provider Business Practice Location Address
First Line	:	1509 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-3319
Country	:	US
Telephone Number	:	213-250-5768
Fax Number	:	213-250-5773

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FREDY PEREZ
Credential	:	O.D.
Telephone Number	:	213-250-5768

Provider Enumeration Date	:	07/21/2007
Last Update Date	:	05/07/2008

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