Healthcare Provider Details

I. General information

NPI: 1285780387
Provider Name (Legal Business Name): ALEXIS PERERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 NW 82ND AVE APT 216
MIAMI FL
33126-6907
US

IV. Provider business mailing address

631 NW 82ND AVE APT 216
MIAMI FL
33126-6907
US

V. Phone/Fax

Practice location:
  • Phone: 305-766-8066
  • Fax: 305-262-2447
Mailing address:
  • Phone: 305-766-8066
  • Fax: 305-262-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME97052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: