Provider Demographics
NPI:1598812174
Name:PEREZ, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5771
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-0771
Mailing Address - Country:US
Mailing Address - Phone:323-336-5585
Mailing Address - Fax:323-843-9417
Practice Address - Street 1:390 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4401
Practice Address - Country:US
Practice Address - Phone:310-640-9911
Practice Address - Fax:310-322-8068
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA56266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A562660Medicaid
CAG75808Medicare UPIN
CA00A562660Medicaid