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General NPI Number Information
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NPI Number | 1114690872
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Entity Type | Individual
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Provider Name | EIDER GARAI PEREZ FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 1524 MCHENRY AVE STE 130
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City | MODESTO
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State | CA
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Zip | 95350-4569
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Country | US
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Telephone | 209-846-3176
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 BIARRITZ ST
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City | TRACY
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State | CA
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Zip | 95304-5950
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Country | US
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Telephone | 209-627-7454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95017910
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95017910
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License Number State | CA
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