Healthcare Provider Details

I. General information

NPI: 1962090431
Provider Name (Legal Business Name): MONICA PEREZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2021
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N PALM AVE STE 211
PEMBROKE PINES FL
33026-3204
US

IV. Provider business mailing address

1065 NE 125TH ST STE 300
NORTH MIAMI FL
33161-5833
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-0010
  • Fax: 954-447-0899
Mailing address:
  • Phone: 888-852-6672
  • Fax: 305-891-4228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: