Provider Demographics
NPI:1760808505
Name:PEREZ, VIANKA
Entity Type:Individual
Prefix:
First Name:VIANKA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 20TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1812
Mailing Address - Country:US
Mailing Address - Phone:305-824-3451
Mailing Address - Fax:305-828-9492
Practice Address - Street 1:7100 W 20TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1812
Practice Address - Country:US
Practice Address - Phone:305-824-3451
Practice Address - Fax:305-828-9492
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13579207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program