Provider Demographics
NPI:1639969041
Name:AZOCAR PEROZO, ROBERTO CARLOS SR (SA)
Entity type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:CARLOS
Last Name:AZOCAR PEROZO
Suffix:SR
Gender:
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9751 MOUNTAIN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5999
Mailing Address - Country:US
Mailing Address - Phone:786-395-4391
Mailing Address - Fax:
Practice Address - Street 1:9751 MOUNTAIN LAKE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5999
Practice Address - Country:US
Practice Address - Phone:786-395-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-603246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant