Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 246541 | TX |
N | 363LC1500X | Nurse Practitioner - Community Health | 246541 | TX |
NPI | 1225225808 |
---|---|
Provider Name | Marta E Perez |
First Address | Edinburg, TX 78539-3432 |
Second Address | Edinburg, TX 78539-3432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 08/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3121147-01 | (05) | TX |
TXB165016 | (02) | TX |