Provider Demographics
NPI:1396444741
Name:PERLA, MERARY MADAI (PA-C)
Entity type:Individual
Prefix:
First Name:MERARY
Middle Name:MADAI
Last Name:PERLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 HARDY ST
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-7122
Mailing Address - Country:US
Mailing Address - Phone:936-215-2236
Mailing Address - Fax:
Practice Address - Street 1:6022 FM 1488 RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2542
Practice Address - Country:US
Practice Address - Phone:281-583-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA16466OtherPA LICENSE NUMBER