Healthcare Provider Details

I. General information

NPI: 1831718733
Provider Name (Legal Business Name): DIANA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

8875 COBBLESTONE POINT CIR
BOYNTON BEACH FL
33472-4455
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0613
  • Fax:
Mailing address:
  • Phone: 561-758-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: