=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508590381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIANY PEREZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2022
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 370 E 1ST AVE
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33010-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-687-1078
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7401 SW 34TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-683-1636
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 26920
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------