Provider Demographics
NPI:1851985345
Name:MELISSA PERURENA HERNANDEZ DPM LLC
Entity Type:Organization
Organization Name:MELISSA PERURENA HERNANDEZ DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERURENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-859-7777
Mailing Address - Street 1:3410 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4935
Mailing Address - Country:US
Mailing Address - Phone:305-859-7777
Mailing Address - Fax:
Practice Address - Street 1:3659 S MIAMI AVE STE 3008
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4225
Practice Address - Country:US
Practice Address - Phone:305-859-7777
Practice Address - Fax:305-859-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty