MEDICARE: MARCO ANTONIO PERERA LLORENS SR. SA-C

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	2999	PR
2	246ZC0007X	Surgical Assistant	24-138	FL
3	363AM0700X	Medical Physician Assistant	2999	PR
4	363AS0400X	Surgical Physician Assistant	2999	PR

General Provider Information

NPI Number	:	1578327474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO ANTONIO PERERA LLORENS SR. SA-C

Provider Business Mailing Address
First Line	:	5200 BAYVIEW DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3436
Country	:	US
Telephone Number	:	954-907-7185
Fax Number	:

Provider Business Practice Location Address
First Line	:	5200 BAYVIEW DR
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-3436
Country	:	US
Telephone Number	:	954-907-7185
Fax Number	:

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/02/2026

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