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General NPI Number Information
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NPI Number | 1942877477
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Entity Type | Individual
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Provider Name | JONATHAN DALIEL PEREZ
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Gender | Male
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 2050 E OSCEOLA PKWY
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City | KISSIMMEE
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State | FL
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Zip | 34743-8602
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Country | US
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Telephone | 407-348-2323
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Fax |
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Provider Business Mailing Address
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Address Line | 12075 STONE BARK TRL
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City | ORLANDO
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State | FL
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Zip | 32824-7394
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Country | US
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Telephone | 787-568-9958
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | RPT93478
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License Number State | FL
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