Provider Demographics
NPI:1730230830
Name:PEREZ, RICARDO JAY (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:JAY
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17600 MONTEREY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3669
Mailing Address - Country:US
Mailing Address - Phone:408-779-0668
Mailing Address - Fax:
Practice Address - Street 1:17600 MONTEREY ST
Practice Address - Street 2:SUITE A
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3669
Practice Address - Country:US
Practice Address - Phone:408-779-0668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG389270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG389270OtherSTATE LICENSE
CAG389270OtherSTATE LICENSE
00G389270Medicare ID - Type Unspecified