Provider Demographics
NPI:1235868571
Name:PEREZ, FIDEL M
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82389 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8526
Mailing Address - Country:US
Mailing Address - Phone:951-396-5584
Mailing Address - Fax:
Practice Address - Street 1:82389 GRANT DR
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-8526
Practice Address - Country:US
Practice Address - Phone:951-396-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program