Healthcare Provider Details

I. General information

NPI: 1619797933
Provider Name (Legal Business Name): CAROLINE PEREZ PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 STATE HIGHWAY 151
SAN ANTONIO TX
78251-1900
US

IV. Provider business mailing address

8018 FERNDALE OAKS
SAN ANTONIO TX
78249-3895
US

V. Phone/Fax

Practice location:
  • Phone: 210-993-2064
  • Fax:
Mailing address:
  • Phone: 561-945-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number40155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: