Healthcare Provider Details

I. General information

NPI: 1659005643
Provider Name (Legal Business Name): GRETEL K PEREZ CORRALES MHTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 SW 27TH AVE STE 506
MIAMI FL
33135-4751
US

IV. Provider business mailing address

1250 SW 27TH AVE STE 506
MIAMI FL
33135-4751
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-9278
  • Fax: 786-536-5185
Mailing address:
  • Phone: 786-536-9278
  • Fax: 786-536-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License NumberMHTC-4688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: