Provider Demographics
NPI:1558647578
Name:PEREZ, YESENIA
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:PROGRESO
Mailing Address - State:TX
Mailing Address - Zip Code:78579-1657
Mailing Address - Country:US
Mailing Address - Phone:956-246-5422
Mailing Address - Fax:
Practice Address - Street 1:1309 N. GONZALEZ RD.
Practice Address - Street 2:
Practice Address - City:PROGRESSO
Practice Address - State:TX
Practice Address - Zip Code:78579
Practice Address - Country:US
Practice Address - Phone:956-246-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport