1447622907 NPI number — EDGAR PEREZ

Table of content: (NPI 1447622907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447622907 NPI number — EDGAR PEREZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDGAR PEREZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447622907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8490
Provider Second Line Business Mailing Address:
PMB 206
Provider Business Mailing Address City Name:
SAN LUIS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85349-6829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-239-5910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
C. 2DA Y CAALLEJON INTERNACIONAL #200-4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS RIO COLORADO
Provider Business Practice Location Address State Name:
SONORA
Provider Business Practice Location Address Postal Code:
83450
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
928-239-5910
Provider Business Practice Location Address Fax Number:
858-430-3143
Provider Enumeration Date:
10/23/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
EDGAR
Authorized Official Middle Name:
ZAID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
928-239-5910

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5496935 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)