Provider Demographics
NPI:1316452634
Name:PEREZ DEL POZO, DAYANA A (MA AND PTA)
Entity type:Individual
Prefix:MS
First Name:DAYANA
Middle Name:A
Last Name:PEREZ DEL POZO
Suffix:
Gender:F
Credentials:MA AND PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 NW 7TH STREET
Mailing Address - Street 2:MARLINS PARK THIRD BASE ENTRANCE
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125
Mailing Address - Country:US
Mailing Address - Phone:305-631-8080
Mailing Address - Fax:
Practice Address - Street 1:1422 NW 7TH STREET
Practice Address - Street 2:MARLINS PARK THIRD BASE ENTRANCE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125
Practice Address - Country:US
Practice Address - Phone:305-631-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22980225200000X
FLMA51038225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA51038OtherMASSAGE THERAPIST
FLPTA22980OtherPHYSICAL THERAPY ASSISTANT