Provider Demographics
NPI:1114754231
Name:PEREZ MARTINEZ, LUIS ERNESTO (SA-C)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ERNESTO
Last Name:PEREZ MARTINEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 SWEETWATER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2478
Mailing Address - Country:US
Mailing Address - Phone:737-293-2182
Mailing Address - Fax:
Practice Address - Street 1:209 SWEETWATER CREEK LN
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-2478
Practice Address - Country:US
Practice Address - Phone:737-293-2182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24-453246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant