MEDICARE: PAOLA NICOLE PEREZ BSW

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1790396133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA NICOLE PEREZ BSW

Provider Business Mailing Address
First Line	:	3618 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7358
Country	:	US
Telephone Number	:	954-512-3158
Fax Number	:	407-210-8443

Provider Business Practice Location Address
First Line	:	3618 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7358
Country	:	US
Telephone Number	:	954-512-3158
Fax Number	:	407-210-8443

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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