Healthcare Provider Details

I. General information

NPI: 1275414559
Provider Name (Legal Business Name): IRENE PERELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 HUFFMEISTER RD
CYPRESS TX
77429-3254
US

IV. Provider business mailing address

12502 SEATTLE SLEW DR
HOUSTON TX
77065-4572
US

V. Phone/Fax

Practice location:
  • Phone: 281-894-1423
  • Fax:
Mailing address:
  • Phone: 818-515-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-365819
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: