Healthcare Provider Details

I. General information

NPI: 1497287213
Provider Name (Legal Business Name): JOSE PERERA ARNP-FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NW 72ND AVE STE 350
MIAMI FL
33126-1947
US

IV. Provider business mailing address

6045 SW 162ND AVE
MIAMI FL
33193-5805
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-1606
  • Fax:
Mailing address:
  • Phone: 786-333-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP-9255335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: