Individual
REBECCA L PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 356-5401
(208) 356-3111
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-4195
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05714
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154618601
—
WI
Enumeration date
07/06/2011
Last updated
08/16/2016
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