1982892410 NPI number — JUAN C PEREZ MORALES MDPA

Table of content: (NPI 1982892410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982892410 NPI number — JUAN C PEREZ MORALES MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUAN C PEREZ MORALES MDPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982892410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8395 SW 73RD AVE APT 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143-7530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-200-2185
Provider Business Mailing Address Fax Number:
305-595-5438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 SW 117TH AVE STE 314
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33183-4826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-395-1441
Provider Business Practice Location Address Fax Number:
888-975-1250
Provider Enumeration Date:
10/10/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PEREZ MORALES
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
305-663-8664

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0059704 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 053493500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".