Healthcare Provider Details

I. General information

NPI: 1275071367
Provider Name (Legal Business Name): DANIEL THOMAS PEREZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5071
APO AP
96328-5071
US

IV. Provider business mailing address

UNIT 5071
APO AP
96328-5071
US

V. Phone/Fax

Practice location:
  • Phone: 315-225-8864
  • Fax:
Mailing address:
  • Phone: 315-225-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP131342
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: