Provider Demographics
NPI:1194470898
Name:PEREZ, ELISAUL (MS)
Entity Type:Individual
Prefix:MR
First Name:ELISAUL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 NW 177TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4921
Mailing Address - Country:US
Mailing Address - Phone:267-439-0025
Mailing Address - Fax:
Practice Address - Street 1:9822 NE 2ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2347
Practice Address - Country:US
Practice Address - Phone:267-439-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH16313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health