Provider Demographics
NPI:1245446780
Name:ALTIERI PEREZ, RICHARD EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EUGENE
Last Name:ALTIERI 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:PTY #11716
Mailing Address - Street 2:PO BOX 25207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33102-3310
Mailing Address - Country:US
Mailing Address - Phone:707-763-3967
Mailing Address - Fax:
Practice Address - Street 1:1456 PROFESSIONAL DR
Practice Address - Street 2:SUITE #404
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6639
Practice Address - Country:US
Practice Address - Phone:707-763-3967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99516208600000X
TXL8594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17174Medicare UPIN