MEDICARE: ILIANA PERERA TORRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	1000076	TX

General Provider Information

NPI Number	:	1386252278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIANA PERERA TORRES

Provider Business Mailing Address
First Line	:	15825 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2331
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15825 BELLAIRE BLVD STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-2347
Country	:	US
Telephone Number	:	832-328-1911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “ ILIANA PERERA TORRES ” Practice Location

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