Provider Demographics
NPI:1033537709
Name:PERALES, PAUL JOSE (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSE
Last Name:PERALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16721 WATERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1514
Mailing Address - Country:US
Mailing Address - Phone:646-318-7035
Mailing Address - Fax:
Practice Address - Street 1:3499 W 4TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4333
Practice Address - Country:US
Practice Address - Phone:305-558-0411
Practice Address - Fax:305-863-3802
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141018208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty