MEDICARE: OLGA LUCIA PEREZ

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	363A00000X	Physician Assistant	9111875	FL

General Provider Information

NPI Number	:	1528524634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA LUCIA PEREZ

Provider Business Mailing Address
First Line	:	3214 SW 154TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4753
Country	:	US
Telephone Number	:	786-617-5633
Fax Number	:

Provider Business Practice Location Address
First Line	:	3214 SW 154TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4753
Country	:	US
Telephone Number	:	786-617-5633
Fax Number	:

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

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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Directions to “ OLGA LUCIA PEREZ ” Practice Location

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