Provider Demographics
NPI:1376124313
Name:PEREZ, EZEQUIEL (PHARM TECH)
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PHARM TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7802 FOOTHILL BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2993
Mailing Address - Country:US
Mailing Address - Phone:818-353-6666
Mailing Address - Fax:818-353-6660
Practice Address - Street 1:7802 FOOTHILL BLVD STE G
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2993
Practice Address - Country:US
Practice Address - Phone:818-353-6666
Practice Address - Fax:818-353-6660
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130720183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician