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General NPI Number Information
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NPI Number | 1578327474
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Entity Type | Individual
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Provider Name | MARCO ANTONIO PERERA LLORENS SR. SA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 5200 BAYVIEW DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3436
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Country | US
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Telephone | 954-907-7185
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 BAYVIEW DR
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-3436
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Country | US
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Telephone | 954-907-7185
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2999
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 24-138
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2999
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 2999
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License Number State | PR
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