Provider Demographics
NPI:1861074155
Name:PEREZ, ANTONIO ELISARRARA JR (RESPIRATORYTHERAPIST)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:ELISARRARA
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:RESPIRATORYTHERAPIST
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8913 TEETERING ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5404
Mailing Address - Country:US
Mailing Address - Phone:702-886-4410
Mailing Address - Fax:
Practice Address - Street 1:8913 TEETERING ROCK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143-5404
Practice Address - Country:US
Practice Address - Phone:702-886-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC2720227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered