Provider Demographics
NPI:1568748127
Name:PERERA, JOSE (MT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PERERA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8532 SW 8TH ST STE 294
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4054
Mailing Address - Country:US
Mailing Address - Phone:305-266-4066
Mailing Address - Fax:
Practice Address - Street 1:8532 SW 8TH ST STE 294
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4054
Practice Address - Country:US
Practice Address - Phone:305-266-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64734247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other