Provider Demographics
NPI:1821360140
Name:PEREZ, ROBERTO T (SURG FIRST ASSIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:T
Last Name:PEREZ
Suffix:
Gender:M
Credentials:SURG FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6023 WAMPUM ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3456
Mailing Address - Country:US
Mailing Address - Phone:210-523-8842
Mailing Address - Fax:
Practice Address - Street 1:6023 WAMPUM ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3456
Practice Address - Country:US
Practice Address - Phone:210-523-8842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant