Provider Demographics
NPI:1003529694
Name:PEREZ, VICTOR ISAAC
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ISAAC
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:PEREZ RUBIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19022 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2823
Mailing Address - Country:US
Mailing Address - Phone:305-931-1617
Mailing Address - Fax:786-431-2576
Practice Address - Street 1:19022 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2823
Practice Address - Country:US
Practice Address - Phone:305-931-1617
Practice Address - Fax:786-431-2576
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-251026106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician