Provider Demographics
NPI:1003538760
Name:PEREZ BERNAL, LILIANA
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:PEREZ BERNAL
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 1:561 SHARAR AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3361
Mailing Address - Country:US
Mailing Address - Phone:305-922-4676
Mailing Address - Fax:
Practice Address - Street 1:561 SHARAR AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3361
Practice Address - Country:US
Practice Address - Phone:305-922-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-156602106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician