Provider Demographics
NPI:1669964763
Name:PEREZ, ANA ISABEL
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:ISABEL
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10903 HIGHLAND MEADOW VLG DR APT 702
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-5365
Mailing Address - Country:US
Mailing Address - Phone:832-746-1855
Mailing Address - Fax:
Practice Address - Street 1:6516 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7880
Practice Address - Country:US
Practice Address - Phone:281-258-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician