Provider Demographics
NPI:1043780513
Name:PEREZ GARCIA, ROSELIO (FNP)
Entity Type:Individual
Prefix:MR
First Name:ROSELIO
Middle Name:
Last Name:PEREZ GARCIA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N GALLOWAY AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-5779
Mailing Address - Country:US
Mailing Address - Phone:305-539-8084
Mailing Address - Fax:469-206-6627
Practice Address - Street 1:2110 N GALLOWAY AVE STE 108
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5779
Practice Address - Country:US
Practice Address - Phone:305-539-8084
Practice Address - Fax:469-206-6627
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF11180340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty