MEDICARE: BIANCA R PEREZ PA

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	363A00000X	Physician Assistant	0010-14821	NC
2	363AM0700X	Medical Physician Assistant	029979	NY
3	363A00000X	Physician Assistant	029979	NY
4	363AS0400X	Surgical Physician Assistant	029979	NY

General Provider Information

NPI Number	:	1578268470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA R PEREZ PA

Provider Business Mailing Address
First Line	:	4705 UNIVERSITY DR BLDG 700
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-3489
Country	:	US
Telephone Number	:	919-237-1337
Fax Number	:	866-538-4716

Provider Business Practice Location Address
First Line	:	9805 SANDY ROCK PL STE E
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-7731
Country	:	US
Telephone Number	:	980-580-0468
Fax Number	:	980-580-0470

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	12/08/2025

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