Provider Demographics
NPI:1942536586
Name:JOSE IGNACIO PEREA INC
Entity Type:Organization
Organization Name:JOSE IGNACIO PEREA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-207-2272
Mailing Address - Street 1:12300 WILSHIRE BLVD. STE# 404
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-207-2272
Mailing Address - Fax:
Practice Address - Street 1:12300 WILSHIRE BLVD. STE#404
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-0000
Practice Address - Country:US
Practice Address - Phone:310-207-2272
Practice Address - Fax:310-207-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48537261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental