Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME114498 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME114498 | FL |
NPI | 1063672061 |
---|---|
Provider Name | Fernando Javier Perez |
First Address | Miami, FL 33175-8101 |
Second Address | Miami, FL 33175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2008 |
Last Update Date | 04/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016959100 | (05) | FL |