Provider Demographics
NPI:1063554509
Name:TRINIDAD PEREZ
Entity type:Organization
Organization Name:TRINIDAD PEREZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-7870
Mailing Address - Street 1:3800 STATE HIGHWAY 6 S STE 108C
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5840
Mailing Address - Country:US
Mailing Address - Phone:979-846-7870
Mailing Address - Fax:979-846-7872
Practice Address - Street 1:3800 STATE HIGHWAY 6 S STE 108C
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5840
Practice Address - Country:US
Practice Address - Phone:979-846-7870
Practice Address - Fax:979-846-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010639251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health