Healthcare Provider Details

I. General information

NPI: 1174947857
Provider Name (Legal Business Name): PERES HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W FAIRMONT PKWY SUITE C
LA PORTE TX
77571-6312
US

IV. Provider business mailing address

505 W FAIRMONT PKWY SUITE C
LA PORTE TX
77571-6312
US

V. Phone/Fax

Practice location:
  • Phone: 713-725-4249
  • Fax:
Mailing address:
  • Phone: 713-725-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number10309
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79417
License Number StateTX

VIII. Authorized Official

Name: DR. VICTOR PERES
Title or Position: MANAGER
Credential: DC
Phone: 713-725-4249