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General NPI Number Information
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NPI Number | 1841086881
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Entity Type | Individual
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Provider Name | EDGAR R PERALTA-LEE APRN
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 111 NW 183RD ST STE 204
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-4578
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Country | US
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Telephone | 305-655-0702
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Fax | 305-655-0845
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Provider Business Mailing Address
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Address Line | 1412 SW 158TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-2368
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Country | US
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Telephone | 347-606-5911
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11038681
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License Number State | FL
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