Provider Demographics
NPI:1083204739
Name:PEREZ, RICHARD IDIEL (RBT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:IDIEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 SE 7TH AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-5332
Mailing Address - Country:US
Mailing Address - Phone:786-457-3913
Mailing Address - Fax:
Practice Address - Street 1:1351 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-5362
Practice Address - Country:US
Practice Address - Phone:786-457-3913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician