Healthcare Provider Details

I. General information

NPI: 1235758210
Provider Name (Legal Business Name): PRISCILLA MARIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 SW 118TH TER
PINECREST FL
33156-4875
US

IV. Provider business mailing address

6240 SW 118TH TER
PINECREST FL
33156-4875
US

V. Phone/Fax

Practice location:
  • Phone: 305-992-9078
  • Fax:
Mailing address:
  • Phone: 305-992-9078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: