Provider Demographics
NPI:1275770323
Name:MANUEL PEREZ-ESPINOSA MD PA
Entity Type:Organization
Organization Name:MANUEL PEREZ-ESPINOSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:PEREZ-ESPINOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-401-8816
Mailing Address - Street 1:3600 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1030
Mailing Address - Country:US
Mailing Address - Phone:305-823-8732
Mailing Address - Fax:305-445-6437
Practice Address - Street 1:3600 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1030
Practice Address - Country:US
Practice Address - Phone:305-444-4520
Practice Address - Fax:305-445-6437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLME23805208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113132400Medicaid