Provider Demographics
NPI:1891063442
Name:PEREZ MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PEREZ MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITEL-ZAMORANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-918-4700
Mailing Address - Street 1:15115 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1914
Mailing Address - Country:US
Mailing Address - Phone:626-918-4700
Mailing Address - Fax:626-918-1170
Practice Address - Street 1:15115 AMAR RD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1914
Practice Address - Country:US
Practice Address - Phone:626-918-4700
Practice Address - Fax:626-918-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-11
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891063442Medicaid