Basic Information
Provider Information
NPI: 1679536437
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERIUT
FirstName: PERLA
MiddleName: ISABEL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9960 NW 116TH WAY
Address2: SUITE 13
City: MEDLEY
State: FL
PostalCode: 331781167
CountryCode: US
TelephoneNumber: 7869241311
FaxNumber: 7869241313
Practice Location
Address1: 8940 N KENDALL DR STE 802E
Address2:  
City: MIAMI
State: FL
PostalCode: 331762151
CountryCode: US
TelephoneNumber: 3055954041
FaxNumber: 3055956638
Other Information
ProviderEnumerationDate: 04/11/2006
LastUpdateDate: 09/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XME81893FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology

No ID Information.


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