Healthcare Provider Details

I. General information

NPI: 1740905033
Provider Name (Legal Business Name): SERGIO LUIS PEREZ LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 WESTWARD DR STE D
MIAMI SPRINGS FL
33166-5296
US

IV. Provider business mailing address

190 WESTWARD DR STE D
MIAMI SPRINGS FL
33166-5296
US

V. Phone/Fax

Practice location:
  • Phone: 786-285-0376
  • Fax:
Mailing address:
  • Phone: 786-285-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: