Provider Demographics
NPI:1164253043
Name:RODOLFO A PEREZ MD
Entity type:Organization
Organization Name:RODOLFO A PEREZ MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARENCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-564-3088
Mailing Address - Street 1:2400 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2919
Mailing Address - Country:US
Mailing Address - Phone:305-859-0569
Mailing Address - Fax:
Practice Address - Street 1:7150 W 20TH AVE STE 304
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5532
Practice Address - Country:US
Practice Address - Phone:305-512-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty