Provider Demographics
NPI:1083471684
Name:PEREZ LOPEZ, JENNEIRY
Entity Type:Individual
Prefix:
First Name:JENNEIRY
Middle Name:
Last Name:PEREZ LOPEZ
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 1:1075 SW 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4948
Mailing Address - Country:US
Mailing Address - Phone:786-280-1051
Mailing Address - Fax:
Practice Address - Street 1:1075 SW 64TH AVE
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4948
Practice Address - Country:US
Practice Address - Phone:786-280-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician