Provider Demographics
NPI:1104334192
Name:PEREZ, BRENDA SELENE
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SELENE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E SABATINA AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7824
Mailing Address - Country:US
Mailing Address - Phone:956-360-7889
Mailing Address - Fax:
Practice Address - Street 1:1309 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5023
Practice Address - Country:US
Practice Address - Phone:956-360-7889
Practice Address - Fax:956-800-5311
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2025-01-09
Deactivation Date:2018-08-01
Deactivation Code:
Reactivation Date:2019-02-04
Provider Licenses
StateLicense IDTaxonomies
TX780789163W00000X
TXAP142519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty