Provider Demographics
NPI:1205886033
Name:PEREZ, ILEANA ROSARIO (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:ROSARIO
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-662-9320
Mailing Address - Fax:305-669-2111
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 200A
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-662-9320
Practice Address - Fax:305-669-2111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME90778207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCI47271Medicare UPIN
DCU65152Medicare ID - Type UnspecifiedMEDICARE