Provider Demographics
NPI:1932677051
Name:PEREZ, ELIZABETH DANIELLE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANIELLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 BRIXTON DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6680
Mailing Address - Country:US
Mailing Address - Phone:956-537-6899
Mailing Address - Fax:
Practice Address - Street 1:1901 N HWY 360 STE 410
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1412
Practice Address - Country:US
Practice Address - Phone:817-652-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health