Basic Information
| Provider Information | |||||||||
| NPI: | 1194803007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HARBOR BLVD | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940024018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508179070 | ||||||||
| FaxNumber: | 6502463838 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HARBOR BLVD | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940024018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508179070 | ||||||||
| FaxNumber: | 6502463838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G41729 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00G417290 | 05 | CA | MEDICAID |