Healthcare Provider Details

I. General information

NPI: 1205444130
Provider Name (Legal Business Name): JOSEPH JOEL PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

IV. Provider business mailing address

807 CHILDRENS WAY
JACKSONVILLE FL
32207-8426
US

V. Phone/Fax

Practice location:
  • Phone: 904-697-3942
  • Fax:
Mailing address:
  • Phone: 904-697-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23624
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: