Provider Demographics
NPI:1831744879
Name:PEREZ LEYVA, RAFAEL ALEJANDRO
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALEJANDRO
Last Name:PEREZ LEYVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 NW 77TH CT STE 313
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2072
Mailing Address - Country:US
Mailing Address - Phone:305-825-4320
Mailing Address - Fax:
Practice Address - Street 1:10550 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-7084
Practice Address - Country:US
Practice Address - Phone:305-825-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator