Healthcare Provider Details

I. General information

NPI: 1952173577
Provider Name (Legal Business Name): DAVID PEREZ MIRABAL DNP, CRNA, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

14308 SW 21ST TER
MIAMI FL
33175-8026
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2345
  • Fax:
Mailing address:
  • Phone: 786-763-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberRN9491355
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11030248
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: