Healthcare Provider Details

I. General information

NPI: 1669687141
Provider Name (Legal Business Name): RENE PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 ST HWY 151 #350 PLAZA 2
SAN ANTONIO TX
78251
US

IV. Provider business mailing address

11212 ST. HWY 151, #350 PLAZA 2
SAN ANTONIO TX
78251
US

V. Phone/Fax

Practice location:
  • Phone: 210-281-5066
  • Fax: 210-281-4459
Mailing address:
  • Phone: 210-281-5066
  • Fax: 210-281-4459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberM6336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: