Provider Demographics
NPI:1053343509
Name:LUIS PEREZ, M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:LUIS PEREZ, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/M.D.
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-865-2332
Mailing Address - Street 1:716 E MISSION BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2040
Mailing Address - Country:US
Mailing Address - Phone:909-865-2332
Mailing Address - Fax:
Practice Address - Street 1:716 E MISSION BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2040
Practice Address - Country:US
Practice Address - Phone:909-865-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G725380Medicaid
CAW16887Medicare ID - Type Unspecified
F23563Medicare UPIN