Provider Demographics
NPI:1639522790
Name:PEREZ, DEIDRA (MED)
Entity Type:Individual
Prefix:
First Name:DEIDRA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 RR 620 N
Mailing Address - Street 2:BLDG B
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2208
Mailing Address - Country:US
Mailing Address - Phone:512-266-9620
Mailing Address - Fax:
Practice Address - Street 1:2903 RR 620 N
Practice Address - Street 2:BLDG B
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2208
Practice Address - Country:US
Practice Address - Phone:512-266-9620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst