Provider Demographics
NPI:1508954983
Name:PEREZ, JOHANNA MARIEL (AP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIEL
Last Name:PEREZ
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 NW 2ND AVE
Mailing Address - Street 2:C 108
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4802
Mailing Address - Country:US
Mailing Address - Phone:561-715-9920
Mailing Address - Fax:561-988-5351
Practice Address - Street 1:4722 NW 2ND AVE
Practice Address - Street 2:C 108
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4802
Practice Address - Country:US
Practice Address - Phone:561-715-9920
Practice Address - Fax:561-988-5351
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2156171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist