Healthcare Provider Details

I. General information

NPI: 1891888913
Provider Name (Legal Business Name): VELMA PAULINO PEREZ P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S 5TH ST
CARRIZO SPRINGS TX
78834-3802
US

IV. Provider business mailing address

302 S 5TH ST
CARRIZO SPRINGS TX
78834-3802
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-9458
  • Fax: 830-876-2411
Mailing address:
  • Phone: 830-876-9458
  • Fax: 830-876-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA03563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: