Provider Demographics
NPI:1992748123
Name:PEREZ, LEOPOLDO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LEOPOLDO
Middle Name:LUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2071 SW 122ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7311
Mailing Address - Country:US
Mailing Address - Phone:305-559-5335
Mailing Address - Fax:
Practice Address - Street 1:33 NE 4TH ST
Practice Address - Street 2:FEDERAL DETENTION CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2111
Practice Address - Country:US
Practice Address - Phone:305-982-1333
Practice Address - Fax:305-982-1343
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist