Basic Information
| Provider Information | |||||||||
| NPI: | 1851375224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | ROLANDO | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 S. EVANS ST | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788016034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302785604 | ||||||||
| FaxNumber: | 8302781836 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 EVANS ST | ||||||||
| Address2: | |||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788015142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302787105 | ||||||||
| FaxNumber: | 8302781836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 03/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA03257 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.