MEDICARE: MRS. ADELAIDA PAULA PEREZ CCPA

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	111N00000X	Chiropractor	CI 477	FL

General Provider Information

NPI Number	:	1689625360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADELAIDA PAULA PEREZ CCPA

Provider Business Mailing Address
First Line	:	3300 W 14TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4704
Country	:	US
Telephone Number	:	786-333-4049
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 WEST 14 AVENUE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012
Country	:	US
Telephone Number	:	786-333-4049
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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