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General NPI Number Information
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NPI Number | 1720286206
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Entity Type | Organization
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Legal Business Name | NEUREX PLLC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 1491 STONY CREEK WAY APT 2
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City | ROCKFORD
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State | IL
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Zip | 61108-1210
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Country | US
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Telephone | 832-425-5634
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7546
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City | ROCKFORD
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State | IL
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Zip | 61126-7546
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Country | US
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Telephone | 832-425-5634
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Fax |
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Authorized Official
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Title or Position | SURGIAL ASSISTANT
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Name | ROLANDO PEREZ
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Credential | IMG LSA
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Telephone | 832-425-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00087
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License Number State | TX
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