Provider Demographics
NPI:1861028912
Name:PAREJA, VICTOR DAVID (CRNA)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:DAVID
Last Name:PAREJA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GRANT ST APT 3074
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3969
Mailing Address - Country:US
Mailing Address - Phone:386-334-6776
Mailing Address - Fax:
Practice Address - Street 1:555 W STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5119
Practice Address - Country:US
Practice Address - Phone:407-831-0945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9446601367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered