Provider Demographics
NPI:1518439157
Name:RETANA-BROWN, PERLA A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PERLA
Middle Name:A
Last Name:RETANA-BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4003 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1313
Mailing Address - Country:US
Mailing Address - Phone:915-791-2114
Mailing Address - Fax:
Practice Address - Street 1:4003 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1313
Practice Address - Country:US
Practice Address - Phone:915-791-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12508363AM0700X
TXTEMPORARY363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty