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NPI Code Detail

MEDICARE: MR. EVERARDO LOPEZ PERNA PA, CSA

MEDICARE: MR. EVERARDO LOPEZ PERNA PA, CSA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant2618PR
2246ZC0007XSurgical AssistantSA342KY

General Provider Information

NPI Number : 1710527510
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVERARDO LOPEZ PERNA PA, CSA
Provider Business Mailing Address
First Line : 129 ARBOR GLEN CT
Second Line :
City : MOUNT WASHINGTON
State : KY
Zip : 40047-5861
Country : US
Telephone Number : 786-461-9972
Fax Number :
Provider Business Practice Location Address
First Line : 4001 KRESGE WAY STE 200
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4640
Country : US
Telephone Number : 502-895-1995
Fax Number : 502-895-6479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2020
Last Update Date : 02/05/2026

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