Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1033774245 |
---|---|
Provider Name | Oliver Perez |
First Address | Van Nuys, CA 91401-3407 |
Second Address | Van Nuys, CA 91406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2019 |
Last Update Date | 02/05/2019 |