Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS8200 | FL |
NPI | 1003845926 |
---|---|
Provider Name | Elena Marta Pernas |
First Address | Miami, FL 33165-3313 |
Second Address | Miami, FL 33165-3313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H21866 | (02) | FL |