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General NPI Number Information
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NPI Number | 1700281086
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Entity Type | Individual
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Provider Name | RUBEN ANGEL PEREZ FNP
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Gender | Male
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 11821 FEDERALIST WAY APT. 11
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City | FAIRFAX
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State | VA
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Zip | 22030-7860
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Country | US
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Telephone | 571-762-3537
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024172159
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License Number State | VA
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