Provider Demographics
NPI:1184180630
Name:PEREZ, ZAIDALIZ MARI
Entity Type:Individual
Prefix:
First Name:ZAIDALIZ
Middle Name:MARI
Last Name:PEREZ
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 1:315 HAWTHORNE HILLS PL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6877
Mailing Address - Country:US
Mailing Address - Phone:787-932-2542
Mailing Address - Fax:
Practice Address - Street 1:315 HAWTHORNE HILLS PL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6877
Practice Address - Country:US
Practice Address - Phone:787-932-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP626993956640OtherDRIVERS LICENSE