MEDICARE: EDDY PEREZ NODARSE

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	207Q00000X	Family Medicine Physician	05240977	FL

General Provider Information

NPI Number	:	1790525194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDY PEREZ NODARSE

Provider Business Mailing Address
First Line	:	10381 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3068
Country	:	US
Telephone Number	:	786-641-1721
Fax Number	:

Provider Business Practice Location Address
First Line	:	10381 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-3068
Country	:	US
Telephone Number	:	786-641-1721
Fax Number	:

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

Provider Enumeration Date	:	05/31/2024
Last Update Date	:	05/31/2024

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Directions to “ EDDY PEREZ NODARSE ” Practice Location

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