Healthcare Provider Details

I. General information

NPI: 1326956988
Provider Name (Legal Business Name): MR. FERNANDO PEREZ RUBIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 SW 107TH AVE
MIAMI FL
33174-2509
US

IV. Provider business mailing address

1409 SW 107TH AVE
MIAMI FL
33174-2509
US

V. Phone/Fax

Practice location:
  • Phone: 305-974-1054
  • Fax: 305-434-7097
Mailing address:
  • Phone: 305-974-1054
  • Fax: 305-434-7097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: