MEDICARE: D VINE BEAUTY STUDIO

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1457942278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D VINE BEAUTY STUDIO

Provider Business Mailing Address
First Line	:	1309 S 10TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-5023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 S 10TH ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-5023
Country	:	US
Telephone Number	:	956-533-3860
Fax Number	:

Authorized Official
Title or Position	:	OWNER/NURSE PRACTITIONER
Name	:	BRENDA PEREZ
Credential	:
Telephone Number	:	956-360-7889

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	07/30/2024

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Directions to “D VINE BEAUTY STUDIO ” Practice Location

Language	Start Address	Practice Location

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