Provider Demographics
NPI:1407274616
Name:PEREZ, ROSAIDA
Entity Type:Individual
Prefix:
First Name:ROSAIDA
Middle Name:
Last Name:PEREZ
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 1:12060 SW 129TH CT
Mailing Address - Street 2:SUITE #107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4582
Mailing Address - Country:US
Mailing Address - Phone:305-378-5247
Mailing Address - Fax:305-378-6760
Practice Address - Street 1:12060 SW 129TH CT
Practice Address - Street 2:SUITE #107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4582
Practice Address - Country:US
Practice Address - Phone:305-378-5247
Practice Address - Fax:305-378-6760
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12060224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant