NPIMap

Organization Active NPI

San Pedro Physical Therapy

  • Specialist
  • San Pedro, CA
National Provider Identifier
1700032455
Registry record updated Mar 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
17929 Issued in CA
Legal business name
SAN PEDRO PHYSICAL THERAPY
Practice address
1366 W 7TH St
Suite 4-B
San Pedro, CA 90732-3500
Phone
(310) 547-2197
Fax
(310) 547-9532
NPI assigned
Aug 13, 2008
Last updated
Mar 22, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2011

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

Authorized official

Name
Dr. Mark Perez, MD
Title
Supervisor
Phone
(310) 547-2197

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 174400000X 17929 CA Primary

Addresses

Primary practice location

1366 W 7TH St
Suite 4-B
San Pedro, CA 90732-3500

Mailing address

1366 W 7TH St
Suite 4-B
San Pedro, CA 90732-3500
Phone (310) 547-3331

Other identifiers 3

IdentifierTypeStateIssuer
17929OtherCAPHYSICAL THERAPY
2838OtherCAPHYSICAL THERAPY
G67514OtherCAMEDICAL BOARD

Other names 1

  • MARK PEREZ, M.D. Other name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1700032455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1366 W 7TH ST",
            "address_2": "SUITE 4-B",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323500",
            "telephone_number": "310-547-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 W 7TH ST",
            "address_2": "SUITE 4-B",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323500",
            "telephone_number": "310-547-2197",
            "fax_number": "310-547-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SUPERVISOR",
        "authorized_official_telephone_number": "310-547-2197",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "17929",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "17929",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY",
            "identifier": "2838",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL BOARD",
            "identifier": "G67514",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARK PEREZ, M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; 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.