MEDICARE: AYDEE A PEREZ

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	2355S0801X	Speech-Language Assistant	36864	TX

General Provider Information

NPI Number	:	1861180663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYDEE A PEREZ

Provider Business Mailing Address
First Line	:	9623 KENNEBEC WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2743
Country	:	US
Telephone Number	:	210-995-5424
Fax Number	:

Provider Business Practice Location Address
First Line	:	9623 KENNEBEC WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-2743
Country	:	US
Telephone Number	:	210-995-5424
Fax Number	:

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

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	04/28/2023

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Directions to “ AYDEE A PEREZ ” Practice Location

Language	Start Address	Practice Location

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