Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4471 | PR |
NPI | 1063448884 |
---|---|
Provider Name | Witiza Perez |
First Address | Riverview, FL 33578-2131 |
Second Address | Riverview, FL 33578-2131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 12/10/2011 |