Provider Demographics
NPI:1083217871
Name:PEREZ, JUAN SEBASTIAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:SEBASTIAN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13324 SW 110TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4345
Mailing Address - Country:US
Mailing Address - Phone:786-395-6944
Mailing Address - Fax:
Practice Address - Street 1:13324 SW 110TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4345
Practice Address - Country:US
Practice Address - Phone:786-395-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist