Healthcare Provider Details

I. General information

NPI: 1063672061
Provider Name (Legal Business Name): FERNANDO JAVIER PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 722
MIAMI FL
33175
US

IV. Provider business mailing address

11760 SW 40TH ST STE 722
MIAMI FL
33175-8101
US

V. Phone/Fax

Practice location:
  • Phone: 305-559-1334
  • Fax:
Mailing address:
  • Phone: 300-559-1334
  • Fax: 305-559-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME114498
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME114498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: