Healthcare Provider Details

I. General information

NPI: 1346400322
Provider Name (Legal Business Name): NELSON M. PEREZ MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 BISCAYNE BLVD
MIAMI FL
33137-3840
US

IV. Provider business mailing address

8501 NW 138TH ST APT 2202
MIAMI LAKES FL
33016-6586
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-1234
  • Fax: 305-571-2020
Mailing address:
  • Phone: 786-343-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: