NPIMap

Individual provider Active NPI

Myrna M. Perez, M.D.

  • Pediatrics Physician
  • Upland, CA
National Provider Identifier
1275745960
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A46537 Issued in CA
Practice address
630 N.13TH Ave.
A
Upland, CA 91786-4975
Phone
(909) 985-7257
Fax
(909) 985-2527
NPI assigned
May 4, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A46537 CA Primary

Addresses

Primary practice location

630 N.13TH Ave.
A
Upland, CA 91786-4975

Mailing address

630 N.13TH Ave.
A
Upland, CA 91786-4975
Phone (909) 985-7257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A46537CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Perez & Perez Medical Corp Pediatrics Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Primecare Medical Group Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275745960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 N.13TH AVE.",
            "address_2": "A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864975",
            "telephone_number": "909-985-7257",
            "fax_number": "909-985-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N.13TH AVE.",
            "address_2": "A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864975",
            "telephone_number": "909-985-7257",
            "fax_number": "909-985-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "MYRNA",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A46537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.