Healthcare Provider Details

I. General information

NPI: 1871805713
Provider Name (Legal Business Name): MRS. ANITA ANN PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA ANN PADILLA

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 MOONCREST DR
HOUSTON TX
77089-7043
US

IV. Provider business mailing address

2111 MOONCREST DR
HOUSTON TX
77089-7043
US

V. Phone/Fax

Practice location:
  • Phone: 832-588-6067
  • Fax:
Mailing address:
  • Phone: 832-588-6067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number112619
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number190109877746604
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: