Provider Demographics
NPI:1003928425
Name:PERERA, GUIBEL (MD)
Entity Type:Individual
Prefix:
First Name:GUIBEL
Middle Name:
Last Name:PERERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261016
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-0018
Mailing Address - Country:US
Mailing Address - Phone:305-392-1000
Mailing Address - Fax:
Practice Address - Street 1:10710 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3619
Practice Address - Country:US
Practice Address - Phone:305-392-1000
Practice Address - Fax:786-332-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15682207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277806800Medicaid
FL09748OtherBCBS
FL277806800Medicaid