Provider Demographics
NPI:1558738435
Name:DE PEREZ, AMALIA (NPII)
Entity Type:Individual
Prefix:
First Name:AMALIA
Middle Name:
Last Name:DE PEREZ
Suffix:
Gender:F
Credentials:NPII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 CIRCLE DRIVE #108
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401
Mailing Address - Country:US
Mailing Address - Phone:818-486-0553
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLAZA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-267-7634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001212282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital