Healthcare Provider Details

I. General information

NPI: 1255789830
Provider Name (Legal Business Name): CIRA PERERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date: 08/08/2018
Reactivation Date: 10/12/2018

III. Provider practice location address

12275 NW 99TH AVE
HIALEAH GARDENS FL
33018-2969
US

IV. Provider business mailing address

12275 NW 99TH AVE
HIALEAH GARDENS FL
33018-2969
US

V. Phone/Fax

Practice location:
  • Phone: 786-617-3402
  • Fax:
Mailing address:
  • Phone: 786-617-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: