Provider Demographics
NPI:1235880808
Name:PEREZ MORALES, ANTONIO (CBHCMS0102658)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:PEREZ MORALES
Suffix:
Gender:M
Credentials:CBHCMS0102658
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NW 7TH ST
Mailing Address - Street 2:E217
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126
Mailing Address - Country:US
Mailing Address - Phone:305-742-5326
Mailing Address - Fax:
Practice Address - Street 1:13335 SW 124TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7513
Practice Address - Country:US
Practice Address - Phone:786-842-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS.0102658104100000X
FL251C00000X
FLCBHCM.0104912171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty