Healthcare Provider Details

I. General information

NPI: 1801705363
Provider Name (Legal Business Name): MIAMI MEDICAL DOCTOR P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GDN DR STE 100
MIAMI FL
33179-4708
US

IV. Provider business mailing address

14792 SW 143RD TER
MIAMI FL
33196-4667
US

V. Phone/Fax

Practice location:
  • Phone: 786-925-3170
  • Fax:
Mailing address:
  • Phone: 786-925-3170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSANNA PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 786-925-3170