Provider Demographics
NPI:1255789830
Name:PERERA, CIRA
Entity type:Individual
Prefix:
First Name:CIRA
Middle Name:
Last Name:PERERA
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 1:12275 NW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2969
Mailing Address - Country:US
Mailing Address - Phone:786-617-3402
Mailing Address - Fax:
Practice Address - Street 1:12275 NW 99TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-2969
Practice Address - Country:US
Practice Address - Phone:786-617-3402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2018-10-12
Deactivation Date:2018-08-08
Deactivation Code:
Reactivation Date:2018-10-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other