Provider Demographics
NPI:1790782464
Name:PEREZ, LAURA MIRAMONTES (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MIRAMONTES
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:MIRAMONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8637 FREDERICKSBURG RD
Mailing Address - Street 2:#360
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1285
Mailing Address - Country:US
Mailing Address - Phone:210-949-4179
Mailing Address - Fax:210-617-4075
Practice Address - Street 1:4243 E SOUTHCROSS BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-3727
Practice Address - Country:US
Practice Address - Phone:210-304-3500
Practice Address - Fax:210-337-2909
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1790Medicare PIN
H74892Medicare UPIN