Provider Demographics
NPI:1770557795
Name:PEREZ-MASUELLI, CARMEN M (MD,)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:M
Last Name:PEREZ-MASUELLI
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22710 PROFESSIONAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6009
Mailing Address - Country:US
Mailing Address - Phone:281-358-2850
Mailing Address - Fax:
Practice Address - Street 1:18488 INTERSTATE 45 S
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:281-315-8130
Practice Address - Fax:281-315-8132
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0506207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162609503Medicaid
TX581658YP67OtherPTAN
TX8HA977OtherBCBS RECORD ID
TX660003425Medicare PIN
TXH22369Medicare UPIN
TX162609501Medicaid
TX8389N0Medicare PIN
TX8070B0Medicare PIN