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General NPI Number Information
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NPI Number | 1326381716
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Entity Type | Individual
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Provider Name | OMAR PEREYRA
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Gender | Male
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | MSC 06 3500 I UNIVERSITY OF NEW MEXICO
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City | ALBUQUERQUE
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State | NM
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Zip | 87131-0001
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Country | US
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Telephone | 505-925-4031
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Fax | 505-925-4030
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Provider Business Mailing Address
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Address Line | 933 BRADBURY DR SE SUITE 2222
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4374
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Country | US
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Telephone | 505-272-9120
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TD-00-53
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD4062
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License Number State | NM
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