Provider Demographics
NPI:1215572508
Name:PERALES, LUIS ENRIQUE
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ENRIQUE
Last Name:PERALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 CALLE SANTOS
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5788
Mailing Address - Country:US
Mailing Address - Phone:830-513-1525
Mailing Address - Fax:
Practice Address - Street 1:1879 S VETERANS BLVD STE 5
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6617
Practice Address - Country:US
Practice Address - Phone:830-513-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-11
Last Update Date:2022-10-21
Deactivation Date:2019-11-20
Deactivation Code:
Reactivation Date:2021-09-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)