Provider Demographics
NPI:1871581447
Name:PEREZ-GROSSMAN, LISA MARIA (MD PA)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIA
Last Name:PEREZ-GROSSMAN
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SW 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3306
Mailing Address - Country:US
Mailing Address - Phone:305-269-1990
Mailing Address - Fax:305-269-1970
Practice Address - Street 1:1235 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3306
Practice Address - Country:US
Practice Address - Phone:305-269-1990
Practice Address - Fax:305-269-1970
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254822400Medicaid
FL254822400Medicaid