Healthcare Provider Details

I. General information

NPI: 1114690872
Provider Name (Legal Business Name): EIDER GARAI PEREZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 130
MODESTO CA
95350-4569
US

IV. Provider business mailing address

1621 BIARRITZ ST
TRACY CA
95304-5950
US

V. Phone/Fax

Practice location:
  • Phone: 209-846-3176
  • Fax:
Mailing address:
  • Phone: 209-627-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95017910
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: