Basic Information
| Provider Information | |||||||||
| NPI: | 1023579133 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | TIFFANY | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 DEPT 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752651408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097720620 | ||||||||
| FaxNumber: | 9184391199 | ||||||||
| Practice Location | |||||||||
| Address1: | 17448 HIGHWAY 3 STE 200 | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8325051748 | ||||||||
| FaxNumber: | 9184391199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2019 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | T6673 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.