Provider Demographics
NPI:1407423957
Name:PEREZ HERNANDEZ, ADRIEL
Entity Type:Individual
Prefix:
First Name:ADRIEL
Middle Name:
Last Name:PEREZ HERNANDEZ
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 1:11611 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4646
Mailing Address - Country:US
Mailing Address - Phone:786-715-2762
Mailing Address - Fax:
Practice Address - Street 1:11611 SW 132ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4646
Practice Address - Country:US
Practice Address - Phone:786-715-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11013330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily