Healthcare Provider Details

I. General information

NPI: 1770416752
Provider Name (Legal Business Name): ANDREA ALEJANDRA FUENZALIDA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 SW 17TH ST
MIAMI FL
33165-7816
US

IV. Provider business mailing address

9100 SW 17TH ST
MIAMI FL
33165-7816
US

V. Phone/Fax

Practice location:
  • Phone: 305-345-8764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number6385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: