Healthcare Provider Details

I. General information

NPI: 1326089244
Provider Name (Legal Business Name): IRIANA PEREZ BELONGIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 N MCMULLEN BOOTH RD BLDG B
CLEARWATER FL
33761-2020
US

IV. Provider business mailing address

504 SHORE DR W
OLDSMAR FL
34677-3420
US

V. Phone/Fax

Practice location:
  • Phone: 727-258-9143
  • Fax: 727-823-7043
Mailing address:
  • Phone: 727-710-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME94154
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME94154
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME94154
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME94154
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: