Healthcare Provider Details

I. General information

NPI: 1114550480
Provider Name (Legal Business Name): ERIC PEREZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9127 W RUSSELL RD STE 110
LAS VEGAS NV
89148-1253
US

IV. Provider business mailing address

PO BOX 840857
DALLAS TX
75284-0857
US

V. Phone/Fax

Practice location:
  • Phone: 702-209-2042
  • Fax: 702-209-2064
Mailing address:
  • Phone: 702-878-0070
  • Fax: 702-209-2064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA828899
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: