Provider Demographics
NPI:1073220141
Name:PEREDA, KARLA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:PEREDA
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 1:11491 NW 2ND ST APT 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4956
Mailing Address - Country:US
Mailing Address - Phone:786-599-7972
Mailing Address - Fax:
Practice Address - Street 1:11491 NW 2ND ST APT 107
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4956
Practice Address - Country:US
Practice Address - Phone:786-599-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-216207106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician