Provider Demographics
NPI:1043791312
Name:PEREZ, JULIAN C (LVN)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:C
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 ANTIGUA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5039
Mailing Address - Country:US
Mailing Address - Phone:361-816-8854
Mailing Address - Fax:
Practice Address - Street 1:5602 ANTIGUA DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5039
Practice Address - Country:US
Practice Address - Phone:361-816-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337319164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse