Provider Demographics
NPI:1841845484
Name:PEREZ, LOURDES MARIA (APRN)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:MARIA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11697 NW 2ND ST APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4955
Mailing Address - Country:US
Mailing Address - Phone:305-303-7979
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 214
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5531
Practice Address - Country:US
Practice Address - Phone:305-826-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily