Provider Demographics
NPI:1467512251
Name:PEREZ, FRITZI A (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRITZI
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:FRITZI
Other - Middle Name:A
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 262465
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2465
Mailing Address - Country:US
Mailing Address - Phone:858-586-9195
Mailing Address - Fax:585-586-9198
Practice Address - Street 1:9750 MIRAMAR RD
Practice Address - Street 2:SUITE #160
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4560
Practice Address - Country:US
Practice Address - Phone:858-586-9195
Practice Address - Fax:858-586-9198
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA399981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3999801Medicaid
CA796360OtherUNITED CONCORDIA