Healthcare Provider Details

I. General information

NPI: 1275624108
Provider Name (Legal Business Name): MRS. NIURKA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 SW 26TH ST
MIAMI FL
33133-2118
US

IV. Provider business mailing address

2980 SW 26TH ST
MIAMI FL
33133-2118
US

V. Phone/Fax

Practice location:
  • Phone: 786-547-4908
  • Fax: 305-441-9252
Mailing address:
  • Phone: 786-547-4908
  • Fax: 305-441-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMA 43317
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: