Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013314228 |
---|---|
Provider Name | Mark Perez |
First Address | Woodland Hills, CA 91364-3301 |
Second Address | Woodland Hills, CA 91364-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 03/12/2014 |