Provider Demographics
NPI:1003395971
Name:FERNANDEZ PEREZ, NEISA
Entity Type:Individual
Prefix:
First Name:NEISA
Middle Name:
Last Name:FERNANDEZ PEREZ
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 1:14750 SW 26TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5937
Mailing Address - Country:US
Mailing Address - Phone:305-364-5533
Mailing Address - Fax:786-332-2919
Practice Address - Street 1:14750 SW 26TH ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5937
Practice Address - Country:US
Practice Address - Phone:305-364-5533
Practice Address - Fax:786-332-2919
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist