Provider Demographics
NPI:1356864300
Name:PEREZ HERNANDEZ, CARLOS MANUEL (ARNP)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:PEREZ HERNANDEZ
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4932 SW 142ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5024
Mailing Address - Country:US
Mailing Address - Phone:786-234-3049
Mailing Address - Fax:
Practice Address - Street 1:4932 SW 142ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-5024
Practice Address - Country:US
Practice Address - Phone:786-234-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
FLF04210204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other