Provider Demographics
NPI:1487871836
Name:TESSA V. PEREZ, M.D.
Entity type:Organization
Organization Name:TESSA V. PEREZ, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-769-1045
Mailing Address - Street 1:1901 HIGHWAY 97 E STE 120
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-1507
Mailing Address - Country:US
Mailing Address - Phone:830-769-1045
Mailing Address - Fax:830-769-1105
Practice Address - Street 1:1901 HIGHWAY 97 E STE 120
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1507
Practice Address - Country:US
Practice Address - Phone:830-769-1045
Practice Address - Fax:830-769-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4641208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00932XMedicare ID - Type UnspecifiedGROUP
TXH75526Medicare UPIN