Provider Demographics
NPI:1326869280
Name:PEREZ HERNANDEZ, SANDRA MARIA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:PEREZ HERNANDEZ
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 1:1919 NORTH LOOP W STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1364
Mailing Address - Country:US
Mailing Address - Phone:713-742-0615
Mailing Address - Fax:713-695-0323
Practice Address - Street 1:1919 NORTH LOOP W STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1364
Practice Address - Country:US
Practice Address - Phone:713-742-0615
Practice Address - Fax:713-695-0323
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
TX1019768363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered Nurse