Provider Demographics
NPI:1811971609
Name:PEREZ, CESAR L (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-5114
Mailing Address - Country:US
Mailing Address - Phone:786-728-3338
Mailing Address - Fax:
Practice Address - Street 1:15260 SW 280TH ST STE 113
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8186
Practice Address - Country:US
Practice Address - Phone:305-998-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14674208D00000X
FLACN623208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
03443OtherAHI
1188OtherPMC
9100000OtherHUMANA
824883OtherMMM
03443OtherAHI
0021453Medicare ID - Type Unspecified