Healthcare Provider Details

I. General information

NPI: 1003288291
Provider Name (Legal Business Name): MR. MIGUEL DE JESUS PEREZ MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9635 SW 181ST TER
PALMETTO BAY FL
33157-5630
US

IV. Provider business mailing address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

V. Phone/Fax

Practice location:
  • Phone: 305-238-8561
  • Fax: 305-238-4089
Mailing address:
  • Phone: 786-485-1005
  • Fax: 786-441-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9383159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: