Healthcare Provider Details

I. General information

NPI: 1326157322
Provider Name (Legal Business Name): ANGEL PEREZ M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15055 EAST FWY STE B60
CHANNELVIEW TX
77530-4192
US

IV. Provider business mailing address

15055 EAST FWY SUITE B-60
CHANNELVIEW TX
77530-4144
US

V. Phone/Fax

Practice location:
  • Phone: 281-452-4444
  • Fax: 281-452-4494
Mailing address:
  • Phone: 281-452-4444
  • Fax: 281-452-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL1693
License Number StateTX

VIII. Authorized Official

Name: ANGEL PEREZ JR.
Title or Position: OWNER
Credential: M.D.
Phone: 281-452-4444