Provider Demographics
NPI:1760017479
Name:PEREZ, FREDERICK (RN, CEN, NP-C)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RN, CEN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26831 ALISO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5341
Mailing Address - Country:US
Mailing Address - Phone:949-382-1909
Mailing Address - Fax:
Practice Address - Street 1:26831 ALISO CREEK RD
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5341
Practice Address - Country:US
Practice Address - Phone:949-382-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily