Provider Demographics
NPI:1376319772
Name:PEREZ, ROMAN JOEL
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:JOEL
Last Name: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 1:63 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-4247
Mailing Address - Country:US
Mailing Address - Phone:386-225-5469
Mailing Address - Fax:
Practice Address - Street 1:63 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-4247
Practice Address - Country:US
Practice Address - Phone:386-225-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)