Basic Information
| Provider Information | |||||||||
| NPI: | 1184890980 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3600 PRYTANIA ST | ||||||||
| Address2: | STE 35 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701153678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048978412 | ||||||||
| FaxNumber: | 5042495311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 250 SOUTH | ||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043496945 | ||||||||
| FaxNumber: | 5043496949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2008 | ||||||||
| LastUpdateDate: | 06/14/2019 | ||||||||
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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 | 207V00000X | 006322283 | LA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1215791 | 05 | LA | MEDICAID |