Provider Demographics
NPI:1477654440
Name:PEREZ, ANGEL GUILLEN (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:GUILLEN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 W TOSCANINI DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1808
Mailing Address - Country:US
Mailing Address - Phone:310-521-1865
Mailing Address - Fax:
Practice Address - Street 1:1721 N WILMINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1261
Practice Address - Country:US
Practice Address - Phone:310-835-1414
Practice Address - Fax:310-835-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G793480Medicaid
CAWG79348FMedicare ID - Type UnspecifiedMD.
CA00G793480Medicaid