Healthcare Provider Details

I. General information

NPI: 1376658757
Provider Name (Legal Business Name): MARY ELLEN ZONDORAK-PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 N STATE ROAD 7 SUITE 340
MARGATE FL
33063-5715
US

IV. Provider business mailing address

2964 N STATE ROAD 7 SUITE 340
MARGATE FL
33063-5715
US

V. Phone/Fax

Practice location:
  • Phone: 954-974-3006
  • Fax: 954-974-8921
Mailing address:
  • Phone: 954-974-3006
  • Fax: 954-974-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0061463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: