Provider Demographics
NPI:1720116635
Name:PEREZ, ALFREDO TRINIDAD
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:TRINIDAD
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FRED
Other - Middle Name:TRINIDAD
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3025 ARTESIA BLVD
Mailing Address - Street 2:UNIT 157
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-2600
Mailing Address - Country:US
Mailing Address - Phone:310-347-2078
Mailing Address - Fax:
Practice Address - Street 1:13710 STUDEBAKER RD
Practice Address - Street 2:UNIT F 100
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-9065
Practice Address - Country:US
Practice Address - Phone:562-933-3585
Practice Address - Fax:562-925-6552
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice