Provider Demographics
NPI:1285237453
Name:PEREZ, PEDRO III
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:PEREZ
Suffix:III
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:414 S WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-5923
Mailing Address - Country:US
Mailing Address - Phone:361-500-2815
Mailing Address - Fax:
Practice Address - Street 1:414 S WRIGHT ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-5923
Practice Address - Country:US
Practice Address - Phone:361-500-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty