Healthcare Provider Details

I. General information

NPI: 1366374381
Provider Name (Legal Business Name): PHANESSA PEREZ A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 S DIXIE HWY
PINECREST FL
33156-1107
US

IV. Provider business mailing address

5709 SW 118TH AVE
MIAMI FL
33183-1721
US

V. Phone/Fax

Practice location:
  • Phone: 305-720-9895
  • Fax:
Mailing address:
  • Phone: 305-389-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: