Basic Information
Provider Information
NPI: 1669964763
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEREZ
FirstName: ANA
MiddleName: ISABEL
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10903 HIGHLAND MEADOW VLG DR APT 702
Address2:  
City: HOUSTON
State: TX
PostalCode: 770895365
CountryCode: US
TelephoneNumber: 8327461855
FaxNumber:  
Practice Location
Address1: 6516 BROADWAY ST
Address2:  
City: PEARLAND
State: TX
PostalCode: 775817880
CountryCode: US
TelephoneNumber: 2812584447
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/04/2018
LastUpdateDate: 06/04/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X TXY    

No ID Information.


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