1467512251 NPI number — DR. FRITZI A PEREZ DMD

Table of content: DR. FRITZI A PEREZ DMD (NPI 1467512251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467512251 NPI number — DR. FRITZI A PEREZ DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
FRITZI
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PEREZ
Provider Other First Name:
FRITZI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467512251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 262465
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92196-2465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-586-9195
Provider Business Mailing Address Fax Number:
585-586-9198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9750 MIRAMAR RD
Provider Second Line Business Practice Location Address:
SUITE #160
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-586-9195
Provider Business Practice Location Address Fax Number:
858-586-9198
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  39998 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B3999801 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 796360 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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