Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9383159 | FL |
NPI | 1003288291 |
---|---|
Provider Name | Mr. Miguel De Jesus Perez Martinez |
First Address | Miami Lakes, FL 33016-1507 |
Second Address | Palmetto Bay, FL 33157-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2015 |
Last Update Date | 03/01/2020 |