Individual
ALISSA J PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
001309
IA
363AM0700X
Medical Physician Assistant
Primary
PA05746
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25402
BLUE SHIELD
IA
01
—
52057B005
TRICARE
—
01
—
IA0109
JOHN DEERE HEALTHCARE
—
Enumeration date
01/25/2007
Last updated
11/01/2016
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