Provider Demographics
NPI:1154552982
Name:PEREZ, ADRIANA MARIA (LAC)
Entity type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:MARIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 NW 185TH WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3862
Mailing Address - Country:US
Mailing Address - Phone:786-286-6746
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD STE 309
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1406
Practice Address - Country:US
Practice Address - Phone:786-286-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2592171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist