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General NPI Number Information
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NPI Number | 1861028912
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Entity Type | Individual
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Provider Name | VICTOR DAVID PAREJA CRNA
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 03/20/2020
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Provider Practice Location Address
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Address Line | 555 W STATE ROAD 434
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City | LONGWOOD
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State | FL
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Zip | 32750-5119
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Country | US
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Telephone | 407-831-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 100 W GRANT ST APT 3074
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City | ORLANDO
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State | FL
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Zip | 32806-3969
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Country | US
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Telephone | 386-334-6776
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9446601
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License Number State | FL
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