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Individual

EMILSE ANTONIO PERAZA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1045 E 3900 S, SALT LAKE CITY, UT 84124-1100
(801) 261-2000
(801) 262-5304
Mailing address
1045 E 3900 S, SALT LAKE CITY, UT 84124-1100
(801) 261-2000
(801) 262-5304

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03160
NC
363A00000X
Physician Assistant
Primary
6777964-1206
UT
363A00000X
Physician Assistant
PA1364
NV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0010-03160
NC MEDICAL LICENSE
NC
01
6777964-1206
UT PA LICENSE
UT
01
PA1364
NV PA LICENSE
NV
Enumeration date
10/13/2011
Last updated
07/14/2023
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