1386848968 NPI number — ALFONSO ENRIQUEZ PEREZ DO

Table of content: ALFONSO ENRIQUEZ PEREZ DO (NPI 1386848968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386848968 NPI number — ALFONSO ENRIQUEZ PEREZ DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
ALFONSO
Provider Middle Name:
ENRIQUEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386848968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7585 KITTY HAWK STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONVERSE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78109-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
104-682-3332
Provider Business Mailing Address Fax Number:
210-667-4044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7330 SAN PEDRO AVE STE 540
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-6250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-344-7287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N0361 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)