Provider Demographics
NPI:1144457508
Name:PERAZA, MARILYN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:PERAZA
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 1:10 NW 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5473
Mailing Address - Country:US
Mailing Address - Phone:305-643-7800
Mailing Address - Fax:305-643-1345
Practice Address - Street 1:10 NW 42ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5473
Practice Address - Country:US
Practice Address - Phone:305-643-7800
Practice Address - Fax:305-643-1345
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1196042084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry