Provider Demographics
NPI:1346610938
Name:PEREZ, JUAN CARLOS (RN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 MAIN ST
Mailing Address - Street 2:APT. 204
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7009
Mailing Address - Country:US
Mailing Address - Phone:954-816-9014
Mailing Address - Fax:
Practice Address - Street 1:6911 MAIN ST
Practice Address - Street 2:APT. 204
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7009
Practice Address - Country:US
Practice Address - Phone:954-816-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9244504163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse