Provider Demographics
NPI:1003580192
Name:PEREZ FERNANDEZ, MAYULI D
Entity Type:Individual
Prefix:
First Name:MAYULI
Middle Name:D
Last Name:PEREZ FERNANDEZ
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 1:7971 SW 152ND AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3222
Mailing Address - Country:US
Mailing Address - Phone:786-488-5833
Mailing Address - Fax:
Practice Address - Street 1:7971 SW 152ND AVE APT 4A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3222
Practice Address - Country:US
Practice Address - Phone:786-488-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120289106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician