Provider Demographics
NPI:1114979895
Name:PEREZ, SALOME (PHD)
Entity Type:Individual
Prefix:
First Name:SALOME
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MADRUGA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3148
Mailing Address - Country:US
Mailing Address - Phone:305-297-4040
Mailing Address - Fax:305-642-3527
Practice Address - Street 1:1508 SAN IGNACIO AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3007
Practice Address - Country:US
Practice Address - Phone:305-297-4040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6103103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical