Provider Demographics
NPI:1417055930
Name:PERENS, ROBERT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:PERENS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4010 SEPULVEDA BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2372
Mailing Address - Country:US
Mailing Address - Phone:310-378-0272
Mailing Address - Fax:310-378-5940
Practice Address - Street 1:4010 SEPULVEDA BLVD
Practice Address - Street 2:STE 3
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2372
Practice Address - Country:US
Practice Address - Phone:310-378-0272
Practice Address - Fax:310-378-5940
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG9538208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA58932Medicare UPIN