Provider Demographics
NPI:1376658757
Name:ZONDORAK-PEREZ, MARY ELLEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:
Last Name:ZONDORAK-PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 N STATE ROAD 7
Mailing Address - Street 2:SUITE 340
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5715
Mailing Address - Country:US
Mailing Address - Phone:954-974-3006
Mailing Address - Fax:954-974-8921
Practice Address - Street 1:2964 N STATE ROAD 7
Practice Address - Street 2:SUITE 340
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5715
Practice Address - Country:US
Practice Address - Phone:954-974-3006
Practice Address - Fax:954-974-8921
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061463208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373952000Medicaid
FL373952000Medicaid