Healthcare Provider Details

I. General information

NPI: 1548059645
Provider Name (Legal Business Name): SAMANTHA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5282 MEDICAL DR
SAN ANTONIO TX
78229-4849
US

IV. Provider business mailing address

1511 SAINT CLOUD RD
SAN ANTONIO TX
78228-3141
US

V. Phone/Fax

Practice location:
  • Phone: 210-447-7373
  • Fax:
Mailing address:
  • Phone: 210-955-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1165660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: