Provider Demographics
NPI:1730161324
Name:PEREZ, JOSEPHINE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S DIXIE HWY
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2228
Mailing Address - Country:US
Mailing Address - Phone:305-666-7766
Mailing Address - Fax:305-666-7766
Practice Address - Street 1:420 S DIXIE HWY
Practice Address - Street 2:SUITE 4A
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2228
Practice Address - Country:US
Practice Address - Phone:305-666-7766
Practice Address - Fax:305-666-7766
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00298542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
02346OtherJACKSON MEM HOSPITAL
02346OtherJACKSON MEM HOSPITAL
79298Medicare ID - Type Unspecified