Provider Demographics
NPI:1649614033
Name:PERENZIN, ALICIA (DOM, AP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:PERENZIN
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12921 SW 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5601
Mailing Address - Country:US
Mailing Address - Phone:305-632-7080
Mailing Address - Fax:
Practice Address - Street 1:9485 SUNSET DR
Practice Address - Street 2:SUITE 245
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3242
Practice Address - Country:US
Practice Address - Phone:305-632-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist