Healthcare Provider Details

I. General information

NPI: 1861028912
Provider Name (Legal Business Name): VICTOR DAVID PAREJA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W STATE ROAD 434
LONGWOOD FL
32750-5119
US

IV. Provider business mailing address

100 W GRANT ST APT 3074
ORLANDO FL
32806-3969
US

V. Phone/Fax

Practice location:
  • Phone: 407-831-0945
  • Fax:
Mailing address:
  • Phone: 386-334-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9446601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: