Provider Demographics
NPI:1982892410
Name:JUAN C PEREZ MORALES MDPA
Entity Type:Organization
Organization Name:JUAN C PEREZ MORALES MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PEREZ MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-663-8664
Mailing Address - Street 1:8395 SW 73RD AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7530
Mailing Address - Country:US
Mailing Address - Phone:786-200-2185
Mailing Address - Fax:305-595-5438
Practice Address - Street 1:8200 SW 117TH AVE STE 314
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4826
Practice Address - Country:US
Practice Address - Phone:305-395-1441
Practice Address - Fax:888-975-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053493500Medicaid
FLK2459Medicare PIN