MEDICARE: MR. MARCEL PEREZ

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	PAT9107451	FL
2	363AM0700X	Medical Physician Assistant	PAT9107451
3	363AS0400X	Surgical Physician Assistant	PAT9107451

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	:	1962837732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCEL PEREZ

Provider Business Mailing Address
First Line	:	16266 SW 97TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-5945
Country	:	US
Telephone Number	:	786-346-5711
Fax Number	:

Provider Business Practice Location Address
First Line	:	16266 SW 97TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-5945
Country	:	US
Telephone Number	:	786-346-5711
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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Directions to “ MR. MARCEL PEREZ ” Practice Location

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