MEDICARE: JULIANA MARIA PEREZ GONZALEZ

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	19476	WI

General Provider Information

NPI Number	:	1770165359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANA MARIA PEREZ GONZALEZ

Provider Business Mailing Address
First Line	:	6729 CROOKED PALM LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2913
Country	:	US
Telephone Number	:	941-840-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	6729 CROOKED PALM LN
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2913
Country	:	US
Telephone Number	:	941-840-2870
Fax Number	:

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

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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