Provider Demographics
NPI:1700610649
Name:PEREZ, JOHN ADAMS EVANGELISTA
Entity type:Individual
Prefix:
First Name:JOHN ADAMS
Middle Name:EVANGELISTA
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CHANDLER AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4064
Mailing Address - Country:US
Mailing Address - Phone:725-204-8809
Mailing Address - Fax:
Practice Address - Street 1:2500 CHANDLER AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4064
Practice Address - Country:US
Practice Address - Phone:725-204-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner