Provider Demographics
NPI:1003296575
Name:PEREZ ALDANA, ALINA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
Last Name:PEREZ ALDANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14482 SW 139TH AVENUE CIR W
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7211
Mailing Address - Country:US
Mailing Address - Phone:786-715-1176
Mailing Address - Fax:
Practice Address - Street 1:14482 SW 139TH AVENUE CIR W
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7211
Practice Address - Country:US
Practice Address - Phone:786-715-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-31
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-5736-11952106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020288100Medicaid
FLRBT-15-5736-11952OtherBACB