Provider Demographics
NPI:1457377368
Name:PEREZ, DONNA BOLTON (PA-C, CWS)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BOLTON
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA-C, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 NW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1186
Mailing Address - Country:US
Mailing Address - Phone:305-431-7861
Mailing Address - Fax:
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:954-424-6377
Practice Address - Fax:954-424-2031
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE75602Medicare ID - Type Unspecified
P61279Medicare UPIN