Healthcare Provider Details

I. General information

NPI: 1639171853
Provider Name (Legal Business Name): AIXSA PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 S WOODLAND BLVD STE A1
DELAND FL
32720-7321
US

IV. Provider business mailing address

955 S WOODLAND BLVD STE A1
DELAND FL
32720-7321
US

V. Phone/Fax

Practice location:
  • Phone: 855-226-6633
  • Fax: 866-285-7068
Mailing address:
  • Phone: 855-226-6633
  • Fax: 866-285-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01049434A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: