Healthcare Provider Details

I. General information

NPI: 1558281493
Provider Name (Legal Business Name): RICHARD PEREZ IZQUIERDO CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

211 NE 169TH ST
NORTH MIAMI BEACH FL
33162-2327
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9321
  • Fax:
Mailing address:
  • Phone: 305-432-9321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number24-491
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: