Provider Demographics
NPI:1174968606
Name:PEREZ, SALVADOR (PA-C)
Entity type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S WOODBERRY LN
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1870
Mailing Address - Country:US
Mailing Address - Phone:626-956-3073
Mailing Address - Fax:
Practice Address - Street 1:720 S WOODBERRY LN
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1870
Practice Address - Country:US
Practice Address - Phone:626-956-3073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22956363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical