Provider Demographics
NPI:1114899051
Name:PEREZ PALACIO, OSVALDO
Entity type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:PEREZ PALACIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 NIGHTINGALE AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3828
Mailing Address - Country:US
Mailing Address - Phone:702-963-4352
Mailing Address - Fax:
Practice Address - Street 1:2525 SW 75TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2800
Practice Address - Country:US
Practice Address - Phone:305-262-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9654089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse