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General NPI Number Information
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NPI Number | 1811557119
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Entity Type | Individual
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Provider Name | MRS. LAUREN MARISA PEREZ
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-5302
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Country | US
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Telephone | 409-772-4610
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Fax |
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Provider Business Mailing Address
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Address Line | 414 MAGNOLIA BLOSSOM
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City | LEAGUE CITY
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State | TX
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Zip | 77573-3797
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Country | US
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Telephone | 409-526-4023
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP141575
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License Number State | TX
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