Provider Demographics
NPI:1013925874
Name:PEREZ, MARIA NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:NICHOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 W HOWARD LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6300
Mailing Address - Country:US
Mailing Address - Phone:512-324-9650
Mailing Address - Fax:
Practice Address - Street 1:3200 RED RIVER ST STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2655
Practice Address - Country:US
Practice Address - Phone:855-841-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMP207R00000X
TXM4309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182342904Medicaid
TX182342904Medicaid
TXCG0510Medicare PIN
TX760010407OtherEIN
TX182342904Medicaid
TX00R518Medicare PIN
TXP00356203Medicare PIN
TX349654YLP1Medicare PIN