Provider Demographics
NPI:1689753857
Name:PEREZ, CARLOS L (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:#505
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-476-2830
Mailing Address - Fax:512-583-1099
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:#505
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-476-2830
Practice Address - Fax:512-583-1099
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04909363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant