Provider Demographics
NPI:1235437880
Name:PEREZ, ROBERTO (MT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SW 27TH AVE STE 960
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3000
Mailing Address - Country:US
Mailing Address - Phone:786-536-3718
Mailing Address - Fax:305-642-5302
Practice Address - Street 1:701 SW 27TH AVE STE 960
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3000
Practice Address - Country:US
Practice Address - Phone:786-536-3718
Practice Address - Fax:305-642-5302
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 59571225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist