1750752556 NPI number — ROSA I PEREZ FAMILY PRACTICE, PLLC

Table of content: (NPI 1750752556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750752556 NPI number — ROSA I PEREZ FAMILY PRACTICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSA I PEREZ FAMILY PRACTICE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROSA I PEREZ, MSN, APRN, FNP-BC FAMILY PRACTICE
Provider Other Organization Name Type Code:
3
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:
1750752556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2557 N VETERANS BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78852-3390
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-872-0074
Provider Business Mailing Address Fax Number:
855-689-6771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2557 N VETERANS BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-3390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-872-0074
Provider Business Practice Location Address Fax Number:
855-689-6771
Provider Enumeration Date:
10/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
ROSA
Authorized Official Middle Name:
IRENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
830-776-6777

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP124282 , 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)





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