Healthcare Provider Details

I. General information

NPI: 1881875029
Provider Name (Legal Business Name): YADIRA PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 BUENAVENTURA BLVD
KISSIMMEE FL
34743-8128
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-344-9959
  • Fax: 407-344-9971
Mailing address:
  • Phone: 407-658-9687
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16970
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: