Provider Demographics
NPI:1992333223
Name:PEREZ, TAIMI (MD)
Entity type:Individual
Prefix:
First Name:TAIMI
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2851
Mailing Address - Country:US
Mailing Address - Phone:954-468-4068
Mailing Address - Fax:
Practice Address - Street 1:6050 W 20TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2605
Practice Address - Country:US
Practice Address - Phone:786-584-5555
Practice Address - Fax:786-584-5050
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME163774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program