Healthcare Provider Details

I. General information

NPI: 1356832448
Provider Name (Legal Business Name): MARLENE PEREZ, CRNA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7887 N KENDALL DR STE 101
MIAMI FL
33156-7494
US

IV. Provider business mailing address

PO BOX 660257
BIRMINGHAM AL
35266-0257
US

V. Phone/Fax

Practice location:
  • Phone: 305-632-2803
  • Fax:
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateCA

VIII. Authorized Official

Name: MARLENE PEREZ
Title or Position: OWNER
Credential: CRNA
Phone: 305-632-2803