Provider Demographics
NPI:1174074694
Name:PEREZ, MANUEL (DO)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21340 NE 8TH CT APT 3
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-1268
Mailing Address - Country:US
Mailing Address - Phone:786-443-0644
Mailing Address - Fax:305-620-3940
Practice Address - Street 1:4500 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-3045
Practice Address - Country:US
Practice Address - Phone:305-620-3901
Practice Address - Fax:305-620-3940
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDO4712156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician