Provider Demographics
NPI:1003288291
Name:PEREZ MARTINEZ, MIGUEL DE JESUS
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:DE JESUS
Last Name:PEREZ MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14750 NW 77TH CT STE 100
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:786-485-1005
Mailing Address - Fax:786-441-2156
Practice Address - Street 1:9635 SW 181ST TER
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5630
Practice Address - Country:US
Practice Address - Phone:305-238-8561
Practice Address - Fax:305-238-4089
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9383159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily