Provider Demographics
NPI:1164974952
Name:PEREZ, ALEXANDRA CHRISTINA (BCABA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:CHRISTINA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 SW 92ND TER
Mailing Address - Street 2:2404
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6848
Mailing Address - Country:US
Mailing Address - Phone:786-423-6673
Mailing Address - Fax:
Practice Address - Street 1:3520 OAKS WAY
Practice Address - Street 2:904
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-5391
Practice Address - Country:US
Practice Address - Phone:305-807-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-16-7344106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst