Healthcare Provider Details

I. General information

NPI: 1275770323
Provider Name (Legal Business Name): MANUEL PEREZ-ESPINOSA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 W FLAGLER ST
MIAMI FL
33135-1030
US

IV. Provider business mailing address

3600 W FLAGLER ST
MIAMI FL
33135-1030
US

V. Phone/Fax

Practice location:
  • Phone: 305-444-4520
  • Fax: 305-445-6437
Mailing address:
  • Phone: 305-823-8732
  • Fax: 305-445-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME23805
License Number StateFL

VIII. Authorized Official

Name: JUAN CARLOS PEREZ-ESPINOSA
Title or Position: PRESIDENT
Credential: DO
Phone: 305-401-8816