Healthcare Provider Details

I. General information

NPI: 1073447306
Provider Name (Legal Business Name): DAITIARA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

16156 NW 22ND ST
PEMBROKE PINES FL
33028-1258
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-3415
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License NumberPS53877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: