Provider Demographics
NPI:1487233326
Name:PEROZO, ANGEL MAURICIO
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MAURICIO
Last Name:PEROZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:MAURICIO
Other - Last Name:PEROZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SONOGRAPHER
Mailing Address - Street 1:4218 HARVEST CREEK CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8086
Mailing Address - Country:US
Mailing Address - Phone:949-609-9309
Mailing Address - Fax:
Practice Address - Street 1:25600 WESTHEIMER PKWY STE 430
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7293
Practice Address - Country:US
Practice Address - Phone:346-229-5995
Practice Address - Fax:281-819-6616
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2067732471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty