Provider Demographics
NPI:1104092121
Name:PEREZ, JUAN E (COTA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:PEREZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 1AND2
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4769
Mailing Address - Country:US
Mailing Address - Phone:956-753-6355
Mailing Address - Fax:956-753-6331
Practice Address - Street 1:102 PALO ALTO RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3773
Practice Address - Country:US
Practice Address - Phone:210-922-1785
Practice Address - Fax:210-922-1782
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
TX121433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX430378601Medicaid