Provider Demographics
NPI:1346731809
Name:FERNANDEZ PEREZ, MICHEL
Entity Type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:
Last Name:FERNANDEZ PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6532
Mailing Address - Country:US
Mailing Address - Phone:305-767-1924
Mailing Address - Fax:305-673-5917
Practice Address - Street 1:429 LENOX AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6532
Practice Address - Country:US
Practice Address - Phone:305-767-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-55619106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician