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1811211683 NPI number — JUAN CARLOS PEREZ MA

NPI Number: 1811211683
Health Care Provider/Practitioner: JUAN CARLOS PEREZ MA

Information about “1811211683” NPI (JUAN CARLOS PEREZ MA) exists in 1811211683 in HTML format HTML  |  1811211683 in plain Text format TXT  |  1811211683 in PDF (Portable Document Format) PDF  |  1811211683 in an XML format XML  formats.

NPI Number : 1811211683 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1811211683",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PEREZ",
    "FirstName": "JUAN",
    "MiddleName": "CARLOS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6916 NW 72ND AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33166-3036",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "305-889-0188",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5881 NW 151ST ST # 220",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MIAMI LAKES",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33014-2497",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "786-631-3738",
    "PracticeLocationAddressFaxNumber": "305-675-2861",
    "EnumerationDate": "03/22/2010",
    "LastUpdateDate": "09/26/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WH0200X",
          "TaxonomyName": "Home Health Registered Nurse",
          "LicenseNumber": "RN9292617",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": "HHC 8276",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "MA33029",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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