Basic Information
| Provider Information | |||||||||
| NPI: | 1467444067 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERLA | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1157 S STATE ROAD 7 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612146695 | ||||||||
| FaxNumber: | 5617537706 | ||||||||
| Practice Location | |||||||||
| Address1: | 1157 S STATE ROAD 7 | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334146101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612146695 | ||||||||
| FaxNumber: | 6175377065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 10/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME98791 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 278887000 | 05 | FL | MEDICAID |