Basic Information
Provider Information
NPI: 1003296575
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEREZ ALDANA
FirstName: ALINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11020 SW 196TH ST APT E-102
Address2:  
City: CUTLER BAY
State: FL
PostalCode: 331578304
CountryCode: US
TelephoneNumber: 7867151176
FaxNumber:  
Practice Location
Address1: 654 NE 9TH PL
Address2:  
City: HOMESTEAD
State: FL
PostalCode: 330304934
CountryCode: US
TelephoneNumber: 3052483488
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2015
LastUpdateDate: 05/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000XRBT-15-5736-11952FLY    

ID Information
IDTypeStateIssuerDescription
02028810005FL MEDICAID
RBT-15-5736-1195201FLBACBOTHER


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