Provider Demographics
NPI:1508496571
Name:PEREZ AZCARIZ, JOAN (SA-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:PEREZ AZCARIZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 W 72ND PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5434
Mailing Address - Country:US
Mailing Address - Phone:786-202-6150
Mailing Address - Fax:
Practice Address - Street 1:2674 W 72ND PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5434
Practice Address - Country:US
Practice Address - Phone:786-202-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13-258246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant