Provider Demographics
NPI:1609689785
Name:PEREZ, GERARDO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 NORTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8003
Mailing Address - Country:US
Mailing Address - Phone:888-605-3154
Mailing Address - Fax:
Practice Address - Street 1:1390 NORTHWESTERN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8003
Practice Address - Country:US
Practice Address - Phone:888-605-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1189719363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health