Provider Demographics
NPI:1558825463
Name:PEREZ, ALIEN R SR (APRN)
Entity Type:Individual
Prefix:MR
First Name:ALIEN
Middle Name:R
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11561 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1959
Mailing Address - Country:US
Mailing Address - Phone:786-538-2750
Mailing Address - Fax:
Practice Address - Street 1:3138 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6738
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV815928363LF0000X
FL11000227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1558825463Medicaid