Provider Demographics
NPI:1902113269
Name:PEREZ, JACKQUELIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKQUELIN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1803
Mailing Address - Country:US
Mailing Address - Phone:713-378-6494
Mailing Address - Fax:713-378-6495
Practice Address - Street 1:3333 BURKE RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1803
Practice Address - Country:US
Practice Address - Phone:713-378-6494
Practice Address - Fax:713-378-6495
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology