Provider Demographics
NPI:1760002125
Name:PEROZO QUIROZ, JENNY KORINA (SA-C)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:KORINA
Last Name:PEROZO QUIROZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S KIRKMAN RD APT 222
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2318
Mailing Address - Country:US
Mailing Address - Phone:407-781-7387
Mailing Address - Fax:
Practice Address - Street 1:1921 S KIRKMAN RD APT 222
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2318
Practice Address - Country:US
Practice Address - Phone:407-781-7387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-485246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty