Healthcare Provider Details

I. General information

NPI: 1811211683
Provider Name (Legal Business Name): JUAN CARLOS PEREZ MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 09/26/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5881 NW 151ST ST # 220
MIAMI LAKES FL
33014-2497
US

IV. Provider business mailing address

6916 NW 72ND AVE
MIAMI FL
33166-3036
US

V. Phone/Fax

Practice location:
  • Phone: 786-631-3738
  • Fax: 305-675-2861
Mailing address:
  • Phone: 305-889-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9292617
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberHHC 8276
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA33029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: