Provider Demographics
NPI:1275830499
Name:PEREZ TAMAYO, ELSIDA M (LSA)
Entity Type:Individual
Prefix:
First Name:ELSIDA
Middle Name:M
Last Name:PEREZ TAMAYO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 38450
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77238-8450
Mailing Address - Country:US
Mailing Address - Phone:281-890-8938
Mailing Address - Fax:281-890-8938
Practice Address - Street 1:11006 WARATH OAK CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5490
Practice Address - Country:US
Practice Address - Phone:281-890-8938
Practice Address - Fax:281-890-8938
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00445363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical