Provider Demographics
NPI:1649508342
Name:IVAN, TATIANA PEREZ (MD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:PEREZ
Last Name:IVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 LINCOLN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2409
Mailing Address - Country:US
Mailing Address - Phone:305-703-7633
Mailing Address - Fax:
Practice Address - Street 1:1111 LINCOLN RD STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2409
Practice Address - Country:US
Practice Address - Phone:305-703-7633
Practice Address - Fax:305-703-7662
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine