Provider Demographics
NPI:1982330809
Name:PEREZ, JESUS GERARDO
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:GERARDO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 PERKINS AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2832
Mailing Address - Country:US
Mailing Address - Phone:956-342-8517
Mailing Address - Fax:
Practice Address - Street 1:1811 PERKINS AVE APT 14
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2832
Practice Address - Country:US
Practice Address - Phone:956-342-8517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64850381235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty