Healthcare Provider Details

I. General information

NPI: 1154139293
Provider Name (Legal Business Name): YANELIZ PERDOMO-PEREZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST # 1149
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST # 1149
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 305-613-0813
  • Fax: 305-243-1730
Mailing address:
  • Phone: 305-613-0813
  • Fax: 305-243-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9236237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: