Healthcare Provider Details

I. General information

NPI: 1043817232
Provider Name (Legal Business Name): TEODULO JOSE PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9035 SUNSET DR STE 202
MIAMI FL
33173-3451
US

IV. Provider business mailing address

2699 STIRLING RD STE B100
FT LAUDERDALE FL
33312-6543
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-3366
  • Fax: 305-271-3355
Mailing address:
  • Phone: 305-223-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: