Provider Demographics
NPI:1346745569
Name:PEREZ PERDIGON, ALIEX
Entity Type:Individual
Prefix:MRS
First Name:ALIEX
Middle Name:
Last Name:PEREZ PERDIGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 N PINE ISLAND RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5200
Mailing Address - Country:US
Mailing Address - Phone:954-376-3739
Mailing Address - Fax:
Practice Address - Street 1:1776 N PINE ISLAND RD STE 106
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5200
Practice Address - Country:US
Practice Address - Phone:954-376-3739
Practice Address - Fax:844-407-9213
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9302310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82-4969884OtherSUYAY HEALTH CARE CORP