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General NPI Number Information
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NPI Number | 1073729372
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Entity Type | Organization
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Legal Business Name | PEREZ GROUP MEDICAL SERVICE CORP
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6595 NW 36TH ST SUITE 200
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6979
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Country | US
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Telephone | 305-876-9008
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Fax | 305-876-9060
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Provider Business Mailing Address
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Address Line | 6595 NW 36TH ST SUITE 200
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City | VIRGINIA GARDENS
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State | FL
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Zip | 33166-6979
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Country | US
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Telephone | 305-876-9008
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Fax | 305-876-9060
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | JESUS M PEREZ
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Credential |
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Telephone | 305-876-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC7384
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License Number State | FL
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