Provider Demographics
NPI:1033601398
Name:PEREA, IVETT
Entity Type:Individual
Prefix:
First Name:IVETT
Middle Name:
Last Name:PEREA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5639
Mailing Address - Country:US
Mailing Address - Phone:321-401-7026
Mailing Address - Fax:321-401-7026
Practice Address - Street 1:809 PATRICK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5639
Practice Address - Country:US
Practice Address - Phone:321-401-7026
Practice Address - Fax:321-401-7026
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker