Provider Demographics
NPI:1205468428
Name:PEREZ, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 106TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-1030
Mailing Address - Country:US
Mailing Address - Phone:786-660-2144
Mailing Address - Fax:
Practice Address - Street 1:10520 NW 26TH ST STE C201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2161
Practice Address - Country:US
Practice Address - Phone:305-364-5182
Practice Address - Fax:305-456-6243
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty