Provider Demographics
NPI:1154359479
Name:PEREZ, RODOLFO ALFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ALFREDO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W 20TH AVE
Mailing Address - Street 2:SUITE# 304
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-512-4411
Mailing Address - Fax:305-557-0939
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:SUITE# 304
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-512-4411
Practice Address - Fax:305-557-0939
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0042866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064589300Medicaid
FLE34394Medicare UPIN
FL94485Medicare PIN