Mario Manuel Perdomo Santa Cruz, RNFA

Primary specialty

Registered Nurse First AssistantTaxonomy code 163WR0006X

License

1174207 Issued in KY

Practice address

4300 Buxton Dr
Louisville, KY 40218-2304

Phone

(786) 675-1616

NPI assigned

Aug 18, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1427776095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 BUXTON DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182304",
            "telephone_number": "786-675-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 BUXTON DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402182304",
            "telephone_number": "786-675-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERDOMO SANTA CRUZ",
        "first_name": "MARIO",
        "middle_name": "MANUEL",
        "credential": "RNFA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-18",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "KY",
            "license": "22-492",
            "primary": false
        },
        {
            "code": "163WR0006X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Registered Nurse First Assistant",
            "state": "KY",
            "license": "1174207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ethan Harrison Perellis, DMD
• Perelmuter & Goldberg Orthodontics

• Registered Nurse First Assistant in Louisville, KY
• Providers in Louisville, KY by specialty
• Registered Nurse First Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.