Provider Demographics
NPI:1962865790
Name:PERALTA HERNANDEZ, LUZ ANGELA (APRN)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:ANGELA
Last Name:PERALTA HERNANDEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ORCHARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4146
Mailing Address - Country:US
Mailing Address - Phone:281-557-8555
Mailing Address - Fax:
Practice Address - Street 1:450 W MEDICAL CENTER BLVD STE 600
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4233
Practice Address - Country:US
Practice Address - Phone:281-332-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130635363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care