Provider Demographics
NPI:1447615679
Name:PEREZ, ALEXIS I (CSA)
Entity Type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
Last Name:PEREZ
Suffix:I
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15540 SW 115TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6313
Mailing Address - Country:US
Mailing Address - Phone:786-521-9131
Mailing Address - Fax:
Practice Address - Street 1:2500 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5925
Practice Address - Country:US
Practice Address - Phone:305-406-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15-654261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care