Healthcare Provider Details

I. General information

NPI: 1639832181
Provider Name (Legal Business Name): ANGELA IDALME PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6746 SW 115TH CT APT 209
MIAMI FL
33173-4897
US

IV. Provider business mailing address

6746 SW 115TH CT APT 209
MIAMI FL
33173-4897
US

V. Phone/Fax

Practice location:
  • Phone: 786-318-8602
  • Fax:
Mailing address:
  • Phone: 786-318-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9671945
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: