Provider Demographics
NPI:1669636825
Name:PEREZ LARA, HUGO (PA)
Entity Type:Individual
Prefix:MR
First Name:HUGO
Middle Name:
Last Name:PEREZ LARA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12177 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1727
Mailing Address - Country:US
Mailing Address - Phone:954-436-0555
Mailing Address - Fax:954-436-0108
Practice Address - Street 1:12177 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1727
Practice Address - Country:US
Practice Address - Phone:954-436-0555
Practice Address - Fax:954-436-0108
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9100602363AM0700X
FLPA9100602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical