Provider Demographics
NPI:1255618906
Name:PEREZ ESTRELLA, GEOVANNY FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:GEOVANNY
Middle Name:FRANCISCO
Last Name:PEREZ ESTRELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEOVANNY
Other - Middle Name:FRANCISCO
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1001 MAIN ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1009
Mailing Address - Country:US
Mailing Address - Phone:716-323-0110
Mailing Address - Fax:716-323-0293
Practice Address - Street 1:1001 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1009
Practice Address - Country:US
Practice Address - Phone:716-323-0110
Practice Address - Fax:716-323-0296
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3016142080P0214X
DCMD039533282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No282NC2000XHospitalsGeneral Acute Care HospitalChildren