Provider Demographics
NPI:1881645802
Name:PEREZ, VIVIANA (MD)
Entity Type:Individual
Prefix:MS
First Name:VIVIANA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 16TH AVE
Mailing Address - Street 2:26
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7146
Mailing Address - Country:US
Mailing Address - Phone:305-822-8883
Mailing Address - Fax:305-825-8273
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:26
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-822-8883
Practice Address - Fax:305-825-8273
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0090686208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267811000Medicaid
FLI06290Medicare UPIN