Provider Demographics
NPI:1629176961
Name:PERURENA, OSVALDO HECTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:HECTOR
Last Name:PERURENA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8300
Mailing Address - Fax:512-324-8301
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-324-3540
Practice Address - Fax:512-324-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL94262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189810803Medicaid
TX189810804Medicaid
TXTXB105622Medicare PIN
TXTXB106428Medicare PIN