Organization
MARK A PEREZ, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A PEREZ MD (MEDICAL DIRECTOR)
(702) 384-7669
Entity
Organization
Contact information
Practice address
4275 BURNHAM AVE, SUITE 235, LAS VEGAS, NV 89119-5488
(702) 384-7669
(702) 385-7669
Mailing address
4275 BURNHAM AVE, SUITE 235, LAS VEGAS, NV 89119-5488
(702) 384-7669
(702) 385-7669
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14517
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14517
NEVADA LICENSE NUMBER
CA
01
—
F38101
MEDICARE UPIN
—
01
—
G00675140
MEDICARE ID
CA
05
—
G00675140
—
CA
Enumeration date
08/27/2012
Last updated
08/27/2012
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