Basic Information
| Provider Information | |||||||||
| NPI: | 1942264031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ | ||||||||
| FirstName: | EVELYN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9100 SW 20TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331658235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053384760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8900 N KENDALL DR | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865962000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA9102201 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 292042500 | 05 | FL | MEDICAID | U0778Y | 01 | FL | MEDICARE | OTHER | U0778Z | 01 | FL | MEDICARE | OTHER |