Provider Demographics
NPI:1457330888
Name:PEREZ & PEREZ MEDICAL CORP
Entity Type:Organization
Organization Name:PEREZ & PEREZ MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-985-7257
Mailing Address - Street 1:630 N 13TH AVE
Mailing Address - Street 2:STE A
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4975
Mailing Address - Country:US
Mailing Address - Phone:909-985-7257
Mailing Address - Fax:909-985-2527
Practice Address - Street 1:630 N 13TH AVE
Practice Address - Street 2:STE A
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4975
Practice Address - Country:US
Practice Address - Phone:909-985-7257
Practice Address - Fax:909-985-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA4649A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty