=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427391986
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN PEREZ APRN,ANP,AGNP,ACHPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2013
-----------------------------------------------------
Last Update Date | 08/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4502 MEDICAL DR # MS 11-1
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-4402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-358-0704
-----------------------------------------------------
Fax | 210-358-2135
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4502 MEDICAL DRIVE MAIL STOP 11-1
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-358-0704
-----------------------------------------------------
Fax | 210-358-2135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 703222
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AP123482
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------