Provider Demographics
NPI:1679010334
Name:PEREZ, JOPHIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JOPHIEL
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 1:4001 NW 97TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2384
Mailing Address - Country:US
Mailing Address - Phone:305-436-7988
Mailing Address - Fax:305-436-3021
Practice Address - Street 1:4001 NW 97TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2384
Practice Address - Country:US
Practice Address - Phone:305-436-7988
Practice Address - Fax:305-436-3021
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110012363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical