Provider Demographics
NPI:1225471535
Name:PEREZ, VICTOR MANUEL
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:PEREZ
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 1:55 SIETE LOMAS ST
Mailing Address - Street 2:RT 2 BOX 546
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6650
Mailing Address - Country:US
Mailing Address - Phone:830-968-0113
Mailing Address - Fax:830-776-5564
Practice Address - Street 1:55 SIETE LOMAS ST
Practice Address - Street 2:RT 2 BOX 546
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6650
Practice Address - Country:US
Practice Address - Phone:830-968-0113
Practice Address - Fax:830-776-5564
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications