Provider Demographics
NPI:1174275614
Name:PEREZ, PALOMA
Entity Type:Individual
Prefix:
First Name:PALOMA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14181 US HIGHWAY 190 W
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:TX
Mailing Address - Zip Code:77360-8091
Mailing Address - Country:US
Mailing Address - Phone:936-223-2156
Mailing Address - Fax:936-646-7543
Practice Address - Street 1:14181 US HIGHWAY 190 W
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:TX
Practice Address - Zip Code:77360-8091
Practice Address - Country:US
Practice Address - Phone:936-646-7541
Practice Address - Fax:936-646-7543
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily