Provider Demographics
NPI:1053091009
Name:FLORIDO PEREZ, EDGAR DE JESUS (SA-C)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:DE JESUS
Last Name:FLORIDO PEREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 SW 93RD ST APT 11-304
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1081
Mailing Address - Country:US
Mailing Address - Phone:786-644-9235
Mailing Address - Fax:
Practice Address - Street 1:17000 SW 93RD ST APT 11-304
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1081
Practice Address - Country:US
Practice Address - Phone:786-644-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-280246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant