=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174275614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PALOMA PEREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2022
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14290 US HIGHWAY 190 W STE B
-----------------------------------------------------
City | ONALASKA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77360-7992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-649-1200
-----------------------------------------------------
Fax | 936-649-1210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14290 US HIGHWAY 190 W STE B
-----------------------------------------------------
City | ONALASKA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77360-7992
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-223-2156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1068779
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------