Provider Demographics
NPI:1548812126
Name:PEREZ, KENIA (APRN-FAMILY)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:APRN-FAMILY
Other - Prefix:
Other - First Name:KENIA
Other - Middle Name:
Other - Last Name:CORBACHO ESTRADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9820 MARTINIQUE DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1738
Mailing Address - Country:US
Mailing Address - Phone:786-779-9178
Mailing Address - Fax:
Practice Address - Street 1:411 SW 27TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2903
Practice Address - Country:US
Practice Address - Phone:786-534-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily