Basic Information
| Provider Information | |||||||||
| NPI: | 1003154907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | ERNESTO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMT | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 917 SW 87TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331743206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052663903 | ||||||||
| FaxNumber: | 3052664749 | ||||||||
| Practice Location | |||||||||
| Address1: | 917 SW 87TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331743206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052663903 | ||||||||
| FaxNumber: | 3052664749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2013 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | MA58518 | FL | Y | Other Service Providers | Legal Medicine |
No ID Information.