Provider Demographics
NPI:1689625360
Name:PEREZ, ADELAIDA PAULA (CCPA)
Entity Type:Individual
Prefix:MRS
First Name:ADELAIDA
Middle Name:PAULA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CCPA
Other - Prefix:MRS
Other - First Name:ADELAIDA
Other - Middle Name:PAULA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BMO
Mailing Address - Street 1:3300 W 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4704
Mailing Address - Country:US
Mailing Address - Phone:786-333-4049
Mailing Address - Fax:
Practice Address - Street 1:3300 WEST 14 AVENUE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:786-333-4049
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCI 477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor