Provider Demographics
NPI:1154607893
Name:PEREZ, GABRIEL (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4770
Mailing Address - Country:US
Mailing Address - Phone:702-619-1701
Mailing Address - Fax:
Practice Address - Street 1:30 HICKORY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-4770
Practice Address - Country:US
Practice Address - Phone:702-628-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy