Provider Demographics
NPI:1447552054
Name:PEREZ, MARTIN GUADALUPE (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:GUADALUPE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7117 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2658
Mailing Address - Country:US
Mailing Address - Phone:951-782-3650
Mailing Address - Fax:951-784-3260
Practice Address - Street 1:7117 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2658
Practice Address - Country:US
Practice Address - Phone:951-782-3650
Practice Address - Fax:951-784-3260
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA148965208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery