Healthcare Provider Details

I. General information

NPI: 1811680036
Provider Name (Legal Business Name): GABRIEL GERARDO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 GUADALUPE ST STE A
LAREDO TX
78040-5280
US

IV. Provider business mailing address

3204 N MAIN ST STE 120
FORT WORTH TX
76106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 956-884-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: