Healthcare Provider Details

I. General information

NPI: 1649786443
Provider Name (Legal Business Name): MAGDA I PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2017
Last Update Date: 12/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 MYSTIC POINT CT
ORLANDO FL
32812-5340
US

IV. Provider business mailing address

5219 MYSTIC POINT CT
ORLANDO FL
32812-5340
US

V. Phone/Fax

Practice location:
  • Phone: 786-510-1797
  • Fax:
Mailing address:
  • Phone: 786-510-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License NumberP620-540-66-758-0
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberP620-549-66-758-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: