Provider Demographics
NPI:1295043115
Name:PEREZ, JUAN ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ALBERTO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 NE 69TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-5704
Mailing Address - Country:US
Mailing Address - Phone:786-953-8729
Mailing Address - Fax:786-953-8729
Practice Address - Street 1:698 NE 69TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5704
Practice Address - Country:US
Practice Address - Phone:786-953-8729
Practice Address - Fax:786-953-8729
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine