Healthcare Provider Details

I. General information

NPI: 1407640048
Provider Name (Legal Business Name): JULIAN DAVID PEREZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 WASHINGTON ST
HOLLYWOOD FL
33021-8216
US

IV. Provider business mailing address

8056 LAKEPOINTE CT
PLANTATION FL
33322-5787
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-4500
  • Fax:
Mailing address:
  • Phone: 407-731-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: