MEDICARE: DIANA NICOLE PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	123728	TX

General Provider Information

NPI Number	:	1336084128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA NICOLE PEREZ

Provider Business Mailing Address
First Line	:	3838 LOCKHILL SELMA RD APT 313
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1570
Country	:	US
Telephone Number	:	830-755-0098
Fax Number	:	830-327-0099

Provider Business Practice Location Address
First Line	:	18 SCENIC LOOP RD # 200D
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78006-8672
Country	:	US
Telephone Number	:	830-755-0098
Fax Number	:	830-327-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ DIANA NICOLE PEREZ ” Practice Location

Language	Start Address	Practice Location

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