Provider Demographics
NPI:1215552484
Name:QUIJANO PEREZ, ANTONIO (RBT)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:QUIJANO PEREZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 W 62ND ST APT 306
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-6037
Mailing Address - Country:US
Mailing Address - Phone:786-704-3116
Mailing Address - Fax:
Practice Address - Street 1:1871 W 62ND ST APT 306
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6037
Practice Address - Country:US
Practice Address - Phone:786-704-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-105844106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician