Healthcare Provider Details

I. General information

NPI: 1801292594
Provider Name (Legal Business Name): ANGEL ADRIAN PEREZ BERMUDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3442 WILSHIRE WAY RD
ORLANDO FL
32829-7354
US

IV. Provider business mailing address

3442 WILSHIRE WAY RD
ORLANDO FL
32829-7354
US

V. Phone/Fax

Practice location:
  • Phone: 305-767-8223
  • Fax:
Mailing address:
  • Phone: 305-767-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: