Healthcare Provider Details

I. General information

NPI: 1225727308
Provider Name (Legal Business Name): ILIANA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CITY CENTRAL AVE
CONROE TX
77304-2981
US

IV. Provider business mailing address

7629 BROOKVIEW DR
FRISCO TX
75034-5421
US

V. Phone/Fax

Practice location:
  • Phone: 936-202-5202
  • Fax:
Mailing address:
  • Phone: 210-859-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: