Provider Demographics
NPI:1356831382
Name:PERALBO PEREZ, JUAN VALENTIN (APRN)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:VALENTIN
Last Name:PERALBO PEREZ
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 NW 14TH ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2114
Mailing Address - Country:US
Mailing Address - Phone:305-243-6099
Mailing Address - Fax:305-243-3381
Practice Address - Street 1:1150 NW 14TH ST STE 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2114
Practice Address - Country:US
Practice Address - Phone:305-243-6099
Practice Address - Fax:305-243-3381
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLF05220156363LF0000X
FLAPRN11019909363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily