Healthcare Provider Details

I. General information

NPI: 1942963202
Provider Name (Legal Business Name): CAROLINA PEREZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SW 71ST ST
SOUTH MIAMI FL
33143-3531
US

IV. Provider business mailing address

5995 SW 71ST ST
SOUTH MIAMI FL
33143-3531
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-6833
  • Fax: 305-666-4030
Mailing address:
  • Phone: 305-305-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9115087
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: