Provider Demographics
NPI:1306408117
Name:CORPIN, DAVID PEREZ JR
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PEREZ
Last Name:CORPIN
Suffix:JR
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 1:1224 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-1091
Mailing Address - Country:US
Mailing Address - Phone:909-500-3786
Mailing Address - Fax:
Practice Address - Street 1:3358 RIBWORT RD
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-8940
Practice Address - Country:US
Practice Address - Phone:909-800-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD9466465172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver