Provider Demographics
NPI:1538136957
Name:PEREZ, RAIZA (MD)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 SW 72ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173
Mailing Address - Country:US
Mailing Address - Phone:305-412-3121
Mailing Address - Fax:305-412-3124
Practice Address - Street 1:9260 SW 72ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-412-3121
Practice Address - Fax:305-412-3124
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
296910OtherAETNA
870737895OtherUNITED
64076OtherBCBS OF FLORIDA
7673751OtherAVMED
9289124OtherCIGNA
170136OtherHUMANA
I17785Medicare UPIN
U3345ZMedicare ID - Type Unspecified