Provider Demographics
NPI:1750752556
Name:ROSA I PEREZ FAMILY PRACTICE, PLLC
Entity type:Organization
Organization Name:ROSA I PEREZ FAMILY PRACTICE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, FNP-BC
Authorized Official - Phone:830-776-6777
Mailing Address - Street 1:2557 N VETERANS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-3390
Mailing Address - Country:US
Mailing Address - Phone:830-872-0074
Mailing Address - Fax:855-689-6771
Practice Address - Street 1:2557 N VETERANS BLVD STE A
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3390
Practice Address - Country:US
Practice Address - Phone:830-872-0074
Practice Address - Fax:855-689-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty