Provider Demographics
NPI:1548038904
Name:SERGIO A PEREZ
Entity type:Organization
Organization Name:SERGIO A PEREZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-352-0417
Mailing Address - Street 1:1010 PALM CANYON DR # 24-1260
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-3104
Mailing Address - Country:US
Mailing Address - Phone:562-352-0417
Mailing Address - Fax:562-366-0560
Practice Address - Street 1:AV. BENITO JUAREZ 191
Practice Address - Street 2:
Practice Address - City:TECATE
Practice Address - State:BC
Practice Address - Zip Code:21400
Practice Address - Country:MX
Practice Address - Phone:562-352-0417
Practice Address - Fax:562-366-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty