Provider Demographics
NPI:1366229726
Name:PEREZ, GIAN CARLOS
Entity type:Individual
Prefix:
First Name:GIAN
Middle Name:CARLOS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GIAN
Other - Middle Name:CARLOS
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15600 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2174
Mailing Address - Country:US
Mailing Address - Phone:239-641-6702
Mailing Address - Fax:
Practice Address - Street 1:15600 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2174
Practice Address - Country:US
Practice Address - Phone:239-641-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach