Healthcare Provider Details

I. General information

NPI: 1972018703
Provider Name (Legal Business Name): PAUL PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

3919 INVIERNO
SAN ANTONIO TX
78223-3817
US

V. Phone/Fax

Practice location:
  • Phone: 844-424-4537
  • Fax:
Mailing address:
  • Phone: 210-373-7679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP135811
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: