Provider Demographics
NPI:1205418647
Name:PICHARDO PEREZ, ODALYS
Entity Type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:PICHARDO PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ODALYS
Other - Middle Name:
Other - Last Name:PICHARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8261 NW 8TH ST APT 339
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3965
Mailing Address - Country:US
Mailing Address - Phone:786-260-3376
Mailing Address - Fax:
Practice Address - Street 1:8261 NW 8TH ST APT 339
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3965
Practice Address - Country:US
Practice Address - Phone:786-260-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140094106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician