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General NPI Number Information
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NPI Number | 1154623379
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Entity Type | Individual
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Provider Name | DR. CECILIA PERERA
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Gender | Female
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 13501 ICOT BLVD STE 101
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City | CLEARWATER
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State | FL
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Zip | 33760-3729
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Country | US
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Telephone | 813-407-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7403
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Country | US
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Telephone | 813-407-3338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30023354
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN19443
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License Number State | FL
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