Provider Demographics
NPI:1366834426
Name:PEREZ, GISELLE (DO)
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SW 150TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2568
Mailing Address - Country:US
Mailing Address - Phone:305-510-6608
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 87TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2655
Practice Address - Country:US
Practice Address - Phone:305-908-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14645207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine