Provider Demographics
NPI:1821072182
Name:PEREZ, RICHARD VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VICTOR
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-2679
Mailing Address - Fax:916-734-6564
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2679
Practice Address - Fax:916-734-6564
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72725204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72725OtherMEDICAL LICENSE
CAG72725OtherMEDICAL LICENSE
CAPE0645521Medicare ID - Type UnspecifiedMEDICARE