Provider Demographics
NPI:1225225808
Name:PEREZ, MARTA E (FNP)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:E
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3432
Mailing Address - Country:US
Mailing Address - Phone:956-627-1197
Mailing Address - Fax:956-627-2071
Practice Address - Street 1:2621 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3432
Practice Address - Country:US
Practice Address - Phone:956-627-1197
Practice Address - Fax:956-627-2071
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246541363LC1500X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3121147-01Medicaid
TXTXB165016Medicare UPIN