Provider Demographics
NPI:1811082449
Name:PEREZ, MARIELA (MD)
Entity type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4702
Mailing Address - Country:US
Mailing Address - Phone:305-245-8858
Mailing Address - Fax:305-245-8865
Practice Address - Street 1:2048 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4702
Practice Address - Country:US
Practice Address - Phone:305-245-8858
Practice Address - Fax:305-245-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI26302Medicare UPIN
FLU4346AMedicare ID - Type Unspecified