Provider Demographics
NPI:1407228281
Name:PEREZ, PEDRO
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name: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 1:7811 CORAL WAY
Mailing Address - Street 2:SUITE 134
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6540
Mailing Address - Country:US
Mailing Address - Phone:305-266-8889
Mailing Address - Fax:
Practice Address - Street 1:7811 CORAL WAY
Practice Address - Street 2:SUITE 134
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-266-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker