Provider Demographics
NPI:1255474375
Name:NARANJO, PERCY (MD)
Entity Type:Individual
Prefix:
First Name:PERCY
Middle Name:
Last Name:NARANJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 ZOE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6995
Mailing Address - Country:US
Mailing Address - Phone:323-638-1038
Mailing Address - Fax:
Practice Address - Street 1:7516 PACIFIC BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6052
Practice Address - Country:US
Practice Address - Phone:323-786-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA351982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50282Medicare UPIN