Healthcare Provider Details

I. General information

NPI: 1154607893
Provider Name (Legal Business Name): GABRIEL PEREZ MEDICAL ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HICKORY ST
LAS VEGAS NV
89110-4770
US

IV. Provider business mailing address

30 HICKORY ST
LAS VEGAS NV
89110-4770
US

V. Phone/Fax

Practice location:
  • Phone: 702-628-1701
  • Fax:
Mailing address:
  • Phone: 702-619-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: