Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A108840 | CA |
Y | 2080P0210X | Pediatric Nephrologist | A108840 | CA |
NPI | 1922328947 |
---|---|
Provider Name | Dr. Elliot Alan Perens |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-2746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 04/05/2017 |