Healthcare Provider Details

I. General information

NPI: 1205886033
Provider Name (Legal Business Name): ILEANA ROSARIO PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE SUITE 200A
SOUTH MIAMI FL
33143-4716
US

IV. Provider business mailing address

7000 SW 62ND AVE SUITE 200A
SOUTH MIAMI FL
33143-4716
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-9320
  • Fax: 305-669-2111
Mailing address:
  • Phone: 305-662-9320
  • Fax: 305-669-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME90778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: