Provider Demographics
NPI:1083962856
Name:MARK A PEREZ, M.D., LLC
Entity Type:Organization
Organization Name:MARK A PEREZ, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-384-7669
Mailing Address - Street 1:4275 BURNHAM AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5488
Mailing Address - Country:US
Mailing Address - Phone:702-384-7669
Mailing Address - Fax:702-385-7669
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-384-7669
Practice Address - Fax:702-385-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00675140Medicaid
CA14517OtherNEVADA LICENSE NUMBER
CAG00675140OtherMEDICARE ID
F38101OtherMEDICARE UPIN