MEDICARE: ALEJANDRO PEREZ OLIVA APRN

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	246ZC0007X	Surgical Assistant	18-549	FL
2	363L00000X	Nurse Practitioner	11022561	FL

General Provider Information

NPI Number	:	1366091787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO PEREZ OLIVA APRN

Provider Business Mailing Address
First Line	:	6304 NW 105TH PL
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-3269
Country	:	US
Telephone Number	:	305-833-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	6307 W 16TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6219
Country	:	US
Telephone Number	:	305-833-4026
Fax Number	:

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

Provider Enumeration Date	:	09/09/2019
Last Update Date	:	12/15/2022

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