Provider Demographics
NPI:1023022647
Name:RIVERA-PEREZ, YDALITH G (LP, PA-C)
Entity Type:Individual
Prefix:DR
First Name:YDALITH
Middle Name:G
Last Name:RIVERA-PEREZ
Suffix:
Gender:F
Credentials:LP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 E WINDHAVEN TERRACE TRL
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2751
Mailing Address - Country:US
Mailing Address - Phone:281-844-0161
Mailing Address - Fax:
Practice Address - Street 1:950 ECHO LN STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2822
Practice Address - Country:US
Practice Address - Phone:281-524-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38335103TC0700X, 103TC0700X
TXPA2105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant