Provider Demographics
NPI:1720286206
Name:NEUREX PLLC
Entity Type:Organization
Organization Name:NEUREX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGIAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:IMG LSA
Authorized Official - Phone:832-425-5634
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61126-7546
Mailing Address - Country:US
Mailing Address - Phone:832-425-5634
Mailing Address - Fax:
Practice Address - Street 1:1491 STONY CREEK WAY
Practice Address - Street 2:APT 2
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1210
Practice Address - Country:US
Practice Address - Phone:832-425-5634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00087363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty