Healthcare Provider Details

I. General information

NPI: 1740824580
Provider Name (Legal Business Name): CHRISTIAN JESUS PEREZ-TORRES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E JACKSON ST
RICHMOND VA
23219-1438
US

IV. Provider business mailing address

VCUHS GME ADMINISTRATION, BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-786-3174
  • Fax: 804-371-8595
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number0101282972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: