MEDICARE: DR. REYNALDO J. PEREZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ACN1120	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306831110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REYNALDO J. PEREZ M.D.

Provider Business Mailing Address
First Line	:	4944 PARKVIEW DR
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7972
Country	:	US
Telephone Number	:	787-466-8754
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 LIVE OAK BLVD STE B
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-8410
Country	:	US
Telephone Number	:	407-734-1273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	01/08/2019

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