Provider Demographics
NPI:1073263547
Name:PEREZ OBRADOR, ANAISA ELVIA
Entity Type:Individual
Prefix:
First Name:ANAISA
Middle Name:ELVIA
Last Name:PEREZ OBRADOR
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 1:9030 ARNDALE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-1530
Mailing Address - Country:US
Mailing Address - Phone:813-241-5177
Mailing Address - Fax:
Practice Address - Street 1:9030 ARNDALE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1530
Practice Address - Country:US
Practice Address - Phone:813-241-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-207902106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician