Provider Demographics
NPI:1598335952
Name:PEREZ ROSARIO, ESMIRNA MARISOL
Entity type:Individual
Prefix:
First Name:ESMIRNA
Middle Name:MARISOL
Last Name:PEREZ ROSARIO
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 1:81 METROPOLITAN OVAL APT 9G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6419
Mailing Address - Country:US
Mailing Address - Phone:718-781-7152
Mailing Address - Fax:
Practice Address - Street 1:11100 SUMMER RIDGE LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4064
Practice Address - Country:US
Practice Address - Phone:844-342-7935
Practice Address - Fax:239-479-5202
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331043207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program