Healthcare Provider Details

I. General information

NPI: 1265352306
Provider Name (Legal Business Name): MANUEL PEREZ JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 ROBINHOOD DR
MARION VA
24354-4613
US

IV. Provider business mailing address

137 ROBINHOOD DR
MARION VA
24354-4613
US

V. Phone/Fax

Practice location:
  • Phone: 276-780-8069
  • Fax:
Mailing address:
  • Phone: 276-780-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024198138
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: