Provider Demographics
NPI:1356694145
Name:PEREZ, ERICA ANN (PH D)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:PEREZ
Other - Last Name:BONURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:402 N JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2868
Mailing Address - Country:US
Mailing Address - Phone:956-540-7509
Mailing Address - Fax:956-560-7510
Practice Address - Street 1:402 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2868
Practice Address - Country:US
Practice Address - Phone:956-540-7510
Practice Address - Fax:956-787-2021
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX36221103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3310989-03Medicaid
TX824130264OtherTAX ID
TX3310989-04Medicaid
TX3310989-05Medicaid