Provider Demographics
NPI:1003459215
Name:ALONSO PERDOMO, DAILYN ELENA
Entity Type:Individual
Prefix:
First Name:DAILYN
Middle Name:ELENA
Last Name:ALONSO PERDOMO
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 1:15019 SW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1431
Mailing Address - Country:US
Mailing Address - Phone:786-454-5380
Mailing Address - Fax:
Practice Address - Street 1:15019 SW 80TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1431
Practice Address - Country:US
Practice Address - Phone:786-454-5380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-102058106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty