Provider Demographics
NPI:1891683744
Name:PERDOMO MARTINEZ, CARLOS MARIO (PA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARIO
Last Name:PERDOMO MARTINEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20755 SW 81ST CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3430
Mailing Address - Country:US
Mailing Address - Phone:786-704-7747
Mailing Address - Fax:
Practice Address - Street 1:20755 SW 81ST CT
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3430
Practice Address - Country:US
Practice Address - Phone:786-704-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002550-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant