Healthcare Provider Details

I. General information

NPI: 1093244972
Provider Name (Legal Business Name): DAVID RUA PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4380 THOMASSON DR
NAPLES FL
34112-6725
US

IV. Provider business mailing address

5221 SW 19TH PL
CAPE CORAL FL
33914-6819
US

V. Phone/Fax

Practice location:
  • Phone: 470-990-8713
  • Fax:
Mailing address:
  • Phone: 786-328-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN24959
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: