Healthcare Provider Details

I. General information

NPI: 1811313794
Provider Name (Legal Business Name): EDWIN PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 E SAHARA AVE
LAS VEGAS NV
89104-2913
US

IV. Provider business mailing address

730 E SAHARA AVE
LAS VEGAS NV
89104-2913
US

V. Phone/Fax

Practice location:
  • Phone: 702-835-2217
  • Fax:
Mailing address:
  • Phone: 702-835-2217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRSS-5360
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: