Provider Demographics
NPI:1518324151
Name:PEREZ LATORRE, CRISTIAN ADRIAN (SA-C)
Entity Type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:ADRIAN
Last Name:PEREZ LATORRE
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 CORBIN AVENUE
Mailing Address - Street 2:APT. 1095
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:818-660-8101
Mailing Address - Fax:
Practice Address - Street 1:6511 VAN NUYS BLVD.
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401
Practice Address - Country:US
Practice Address - Phone:818-901-9090
Practice Address - Fax:714-375-3889
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14-646246ZC0007X
CA1601474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant