Provider Demographics
NPI:1083227516
Name:PEREZ, ALEX (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 WOODBURY SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2000
Mailing Address - Country:US
Mailing Address - Phone:646-833-5986
Mailing Address - Fax:
Practice Address - Street 1:101 W KOENIG LN UNIT 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-1273
Practice Address - Country:US
Practice Address - Phone:833-937-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309926363LA2200X
TX1088094363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health