Healthcare Provider Details

I. General information

NPI: 1659508372
Provider Name (Legal Business Name): OMAR PEREZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OMAR PEREZ-FIGUEROA CRNA

II. Dates (important events)

Enumeration Date: 06/20/2009
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 GAFFNEY RD, FORT WAINWRIGHT, AK 99703
FT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

1270 SUMMIT DRIVE
FAIRBANKS AK
99712
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5658
  • Fax:
Mailing address:
  • Phone: 787-674-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9218623
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9218623
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: