Provider Demographics
NPI:1053683540
Name:PEREZ, RAFAEL (LAC)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W FLAGLER ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1806
Mailing Address - Country:US
Mailing Address - Phone:305-547-8448
Mailing Address - Fax:
Practice Address - Street 1:28 W FLAGLER ST
Practice Address - Street 2:SUITE 550
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1806
Practice Address - Country:US
Practice Address - Phone:305-547-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist