MEDICARE: LOURDES MARIA PEREZ APRN

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	363LF0000X	Family Nurse Practitioner	APRN11003572	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841845484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOURDES MARIA PEREZ APRN

Provider Business Mailing Address
First Line	:	11697 NW 2ND ST APT 202
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33172-4955
Country	:	US
Telephone Number	:	305-303-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 W 20TH AVE STE 214
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5531
Country	:	US
Telephone Number	:	305-826-8606
Fax Number	:

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

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	09/15/2019

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Directions to “ LOURDES MARIA PEREZ APRN” Practice Location

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