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General NPI Number Information
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NPI Number | 1285121558
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Entity Type | Individual
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Provider Name | INDIRA LIZZETH PERALES TREJO
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Gender | Female
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Dates
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Enumeration Date | 04/22/2018
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1116 E 8TH ST STE 2
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City | WESLACO
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State | TX
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Zip | 78596-7288
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Country | US
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Telephone | 956-969-0999
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 W LIVE OAK DR
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City | WESLACO
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State | TX
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Zip | 78596-7707
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Country | US
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Telephone | 832-335-6921
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10063188
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T2470
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License Number State | TX
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