Provider Demographics
NPI:1447976659
Name:PADRON PEREZ, MICHEL ESTEBAN
Entity type:Individual
Prefix:
First Name:MICHEL
Middle Name:ESTEBAN
Last Name:PADRON PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4596 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1938
Mailing Address - Country:US
Mailing Address - Phone:352-777-5571
Mailing Address - Fax:
Practice Address - Street 1:4596 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1938
Practice Address - Country:US
Practice Address - Phone:352-777-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver