Provider Demographics
NPI:1336786839
Name:PEREZ, BENJAMIN GABRIEL JR
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GABRIEL
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N UTICA AVE # 212A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3034
Mailing Address - Country:US
Mailing Address - Phone:210-687-5093
Mailing Address - Fax:
Practice Address - Street 1:315 N UTICA AVE # 212A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3034
Practice Address - Country:US
Practice Address - Phone:210-687-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program