Provider Demographics
NPI:1538832647
Name:PEREZ MARVAL, CANDIDA ROSA (MT)
Entity type:Individual
Prefix:
First Name:CANDIDA ROSA
Middle Name:
Last Name:PEREZ MARVAL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 YOUNGER DR
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-3509
Mailing Address - Country:US
Mailing Address - Phone:469-740-2626
Mailing Address - Fax:
Practice Address - Street 1:6840 YOUNGER DR
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3509
Practice Address - Country:US
Practice Address - Phone:469-740-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT133977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist