Provider Demographics
NPI:1356510952
Name:PEREZ, SANDRA P (FNP)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:P
Last Name:PEREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:P.O. BOX 451490
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-722-5007
Mailing Address - Fax:956-725-5512
Practice Address - Street 1:3527 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043
Practice Address - Country:US
Practice Address - Phone:956-722-5007
Practice Address - Fax:956-725-5512
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608198363LF0000X
TXAP116122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX338146YDDKMedicare PIN