=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477443182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAUL IVAN PEREZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2025
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21402 CARLEEN CREEK TRL
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-628-1477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21402 CARLEEN CREEK TRL
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-5239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-628-1477
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number | TJK9597
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------