Provider Demographics
NPI:1700520046
Name:PEREZ, CESAR AUGUSTO
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:AUGUSTO
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 1:2664 S NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8420
Mailing Address - Country:US
Mailing Address - Phone:980-320-4665
Mailing Address - Fax:704-943-0590
Practice Address - Street 1:2664 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8420
Practice Address - Country:US
Practice Address - Phone:980-320-4665
Practice Address - Fax:704-943-0590
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24149329343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)