Healthcare Provider Details

I. General information

NPI: 1760462162
Provider Name (Legal Business Name): IRENE PEREZ YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S MCCOLL RD
EDINBURG TX
78539-5503
US

IV. Provider business mailing address

4500 S GARNETT RD STE 300
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036146549
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2017044649
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberL4642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: