Provider Demographics
NPI:1457459547
Name:PEREZ, LEONARDO (PA)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 E MCFADDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4106
Mailing Address - Country:US
Mailing Address - Phone:714-542-1331
Mailing Address - Fax:714-542-4758
Practice Address - Street 1:1226 E MCFADDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4106
Practice Address - Country:US
Practice Address - Phone:714-542-1331
Practice Address - Fax:714-542-4758
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPA14221JMedicare ID - Type Unspecified
P42193Medicare UPIN