MEDICARE: MRS. DONNA BOLTON PEREZ PA-C, CWS

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	363A00000X	Physician Assistant	PA9101819	FL

General Provider Information

NPI Number	:	1457377368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA BOLTON PEREZ PA-C, CWS

Provider Business Mailing Address
First Line	:	662 NW 90TH TER
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-1186
Country	:	US
Telephone Number	:	305-431-7861
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W SUNRISE BLVD
Second Line	:	SUITE 109
City	:	PLANTATION
State	:	FL
Zip	:	33322-5435
Country	:	US
Telephone Number	:	954-424-6377
Fax Number	:	954-424-2031

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/30/2008

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Directions to “ MRS. DONNA BOLTON PEREZ PA-C, CWS” Practice Location

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