Provider Demographics
NPI:1578577664
Name:PERER, ELISE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:S
Last Name:PERER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:18350 ROSCOE BLVD
Mailing Address - Street 2:SUITE 701
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4109
Mailing Address - Country:US
Mailing Address - Phone:818-885-9400
Mailing Address - Fax:818-885-9403
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 701
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-885-9400
Practice Address - Fax:818-885-9403
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-12-07
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Provider Licenses
StateLicense IDTaxonomies
CAA77355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA77355OtherLICENSE
CAWA73355CMedicare PIN