Provider Demographics
NPI:1548265119
Name:GARCIA-PEREZ, PABLO-MOISES (CRNA)
Entity type:Individual
Prefix:
First Name:PABLO-MOISES
Middle Name:
Last Name:GARCIA-PEREZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:MOISES
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1705 AQUILA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1798
Mailing Address - Country:US
Mailing Address - Phone:719-542-9093
Mailing Address - Fax:
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-560-5430
Practice Address - Fax:719-560-5448
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164987207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86484711Medicaid
CO86484711Medicaid
515698Medicare ID - Type Unspecified