Provider Demographics
NPI:1295926749
Name:PEREZ DIAZ, SUSANA GEMA (MD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:GEMA
Last Name:PEREZ DIAZ
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 850001, DEPT 8340
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32885-0001
Mailing Address - Country:US
Mailing Address - Phone:855-536-7277
Mailing Address - Fax:855-830-1722
Practice Address - Street 1:1094 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7021
Practice Address - Country:US
Practice Address - Phone:561-622-6111
Practice Address - Fax:855-215-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2025-10-27
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Provider Licenses
StateLicense IDTaxonomies
FL100551207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine