Healthcare Provider Details

I. General information

NPI: 1609620459
Provider Name (Legal Business Name): CECILIA PEREZ MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 DEZAVALA RD SUITE 403
SAN ANTONIO TX
78249
US

IV. Provider business mailing address

1190 LATIGO BLVD
PIPE CREEK TX
78063-6689
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax:
Mailing address:
  • Phone: 830-688-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1153164
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: