Provider Demographics
NPI:1659876803
Name:ERICA ANN. PEREZ, PHD. PC
Entity Type:Organization
Organization Name:ERICA ANN. PEREZ, PHD. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:956-540-7509
Mailing Address - Street 1:402 N JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2868
Mailing Address - Country:US
Mailing Address - Phone:956-540-7509
Mailing Address - Fax:956-540-7510
Practice Address - Street 1:402 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2868
Practice Address - Country:US
Practice Address - Phone:956-540-7509
Practice Address - Fax:956-540-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36221103T00000X
103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4115909-01Medicaid