MEDICARE: SELIDETH AMARILYS PEREZ-RIVERO LM, CMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	MW399	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194317164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELIDETH AMARILYS PEREZ-RIVERO LM, CMP

Provider Business Mailing Address
First Line	:	1533 ELMWOOD AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-4010
Country	:	US
Telephone Number	:	787-360-9571
Fax Number	:	407-942-2044

Provider Business Practice Location Address
First Line	:	751 19TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-5310
Country	:	US
Telephone Number	:	787-360-9571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	01/17/2023

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