Individual
MR. JESUS MANUEL PEREIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12423 SW 104TH LN, MIAMI, FL 33186-3610
(305) 301-4046
Mailing address
12423 SW 104TH LN, MIAMI, FL 33186-3610
(305) 301-4046
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 9101868
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 9101868
PA LICENSE
FL
Enumeration date
03/12/2007
Last updated
07/08/2007
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