Healthcare Provider Details

I. General information

NPI: 1407930589
Provider Name (Legal Business Name): ANA M. VERDEJA PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W TIMBERLANE DR STE 400
PLANT CITY FL
33566
US

IV. Provider business mailing address

1601 W TIMBERLANE DR STE 400
PLANT CITY FL
33566-0957
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-6677
  • Fax: 813-443-8153
Mailing address:
  • Phone: 813-321-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME78928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: