Provider Demographics
NPI:1427559822
Name:PEREA, VICTOR ALEXANDER (BS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALEXANDER
Last Name:PEREA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32211 SKY WAY LN
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-9052
Mailing Address - Country:US
Mailing Address - Phone:832-388-8964
Mailing Address - Fax:
Practice Address - Street 1:32211 SKY WAY LN
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-9052
Practice Address - Country:US
Practice Address - Phone:832-388-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX401012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant