Individual
MARIO MANUEL PERDOMO SANTA CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
4300 BUXTON DR, LOUISVILLE, KY 40218-2304
(786) 675-1616
Mailing address
4300 BUXTON DR, LOUISVILLE, KY 40218-2304
(786) 675-1616
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
1174207
KY
246ZC0007X
Surgical Assistant
22-492
KY
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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