Healthcare Provider Details

I. General information

NPI: 1588135719
Provider Name (Legal Business Name): ALEJANDRO DANIEL PEREZ IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WILDERNESS TRL & CAMP BULLIS
SAN ANTONIO TX
78257
US

IV. Provider business mailing address

3059 COPENHAGEN RD
RIVERSIDE CA
92504-4261
US

V. Phone/Fax

Practice location:
  • Phone: 210-295-8337
  • Fax:
Mailing address:
  • Phone: 951-207-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: