Provider Demographics
NPI:1467037580
Name:PEREDA, MARIA DE JESUS
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:PEREDA
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 1:3869 SW 153RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4717
Mailing Address - Country:US
Mailing Address - Phone:786-393-8853
Mailing Address - Fax:
Practice Address - Street 1:2623 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5622
Practice Address - Country:US
Practice Address - Phone:305-677-0227
Practice Address - Fax:866-381-6623
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011664363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily