Provider Demographics
NPI:1073128005
Name:PEREZ VARGAS, IDALBERTO (ARNP)
Entity Type:Individual
Prefix:
First Name:IDALBERTO
Middle Name:
Last Name:PEREZ VARGAS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15890 SW 85TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5208
Mailing Address - Country:US
Mailing Address - Phone:305-215-2703
Mailing Address - Fax:
Practice Address - Street 1:15890 SW 85TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5208
Practice Address - Country:US
Practice Address - Phone:305-215-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily