Provider Demographics
NPI:1326571928
Name:RODRIGUEZ PEREZ, MIGUEL ALEXANDER
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ALEXANDER
Last Name:RODRIGUEZ PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 PACIFIC BLVD
Mailing Address - Street 2:APT 4107
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-6722
Mailing Address - Country:US
Mailing Address - Phone:954-940-8449
Mailing Address - Fax:
Practice Address - Street 1:5541 PACIFIC BLVD
Practice Address - Street 2:APT 4107
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-6722
Practice Address - Country:US
Practice Address - Phone:954-940-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW 347176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife