Healthcare Provider Details

I. General information

NPI: 1194464065
Provider Name (Legal Business Name): ARLES PERDOMO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 502
HIALEAH FL
33013-3834
US

IV. Provider business mailing address

777 E 25TH ST STE 502
HIALEAH FL
33013-3834
US

V. Phone/Fax

Practice location:
  • Phone: 305-497-6688
  • Fax: 786-553-2667
Mailing address:
  • Phone: 305-497-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ARLES PERDOMO
Title or Position: OWNER
Credential: MD,PA
Phone: 786-683-1865