Provider Demographics
NPI:1659977684
Name:PEREZ, ERICK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 NW 7TH ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3809
Mailing Address - Country:US
Mailing Address - Phone:786-253-8056
Mailing Address - Fax:
Practice Address - Street 1:250 SE 23RD AVE STE B
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7659
Practice Address - Country:US
Practice Address - Phone:561-753-8366
Practice Address - Fax:561-721-0077
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
FLPA9113885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty