Provider Demographics
NPI:1588135719
Name:PEREZ, ALEJANDRO DANIEL (IDMT)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:DANIEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 COPENHAGEN RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4261
Mailing Address - Country:US
Mailing Address - Phone:951-207-1398
Mailing Address - Fax:
Practice Address - Street 1:WILDERNESS TRL & CAMP BULLIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-295-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians