Organization
CEPJASSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRISTOBAL E PEREZ PA-C (SOLE PROPRIETOR)
(210) 408-0605
Entity
Organization
Contact information
Practice address
3023 IVORY CRK, SAN ANTONIO, TX 78258-1603
(210) 408-0605
Mailing address
3023 IVORY CRK, SAN ANTONIO, TX 78258-1603
(210) 408-0605
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04389
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202342601
—
TX
Enumeration date
09/10/2010
Last updated
09/10/2010
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