Provider Demographics
NPI:1194067033
Name:PEREZ, JUAN A (MA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9360 SW 72ND ST STE 212
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3273
Mailing Address - Country:US
Mailing Address - Phone:786-362-5555
Mailing Address - Fax:786-536-2510
Practice Address - Street 1:9360 SW 72ND ST STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3273
Practice Address - Country:US
Practice Address - Phone:786-362-5555
Practice Address - Fax:786-464-0624
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA25979225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist