Healthcare Provider Details

I. General information

NPI: 1780794040
Provider Name (Legal Business Name): CENTER FOR UROGYNECOLOGY & ADVANCED LAPAROSOCPIC SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE SUITE 545-A
SOUTH MIAMI FL
33143-4724
US

IV. Provider business mailing address

7000 SW 62ND AVE SUITE 545-A
SOUTH MIAMI FL
33143-4724
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-2060
  • Fax: 305-665-4090
Mailing address:
  • Phone: 305-665-2060
  • Fax: 305-665-4090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME75777
License Number StateFL

VIII. Authorized Official

Name: RAFAEL J PEREZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 305-665-2060