Provider Demographics
NPI:1710348628
Name:PEREZ ANDREU, VIRGINIA (MD PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:PEREZ ANDREU
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 LYNN RD STE 330
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1989
Mailing Address - Country:US
Mailing Address - Phone:805-309-0525
Mailing Address - Fax:
Practice Address - Street 1:2230 LYNN RD STE 330
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1989
Practice Address - Country:US
Practice Address - Phone:805-309-0525
Practice Address - Fax:805-624-3150
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18545207R00000X
CAA163439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL2752OtherNEVADA BOARD OF MEDICAL EXAMINERS