Provider Demographics
NPI:1417709593
Name:LICEA PEREZ, YUMISLEIDY Y
Entity Type:Individual
Prefix:
First Name:YUMISLEIDY
Middle Name:Y
Last Name:LICEA PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 SW 20TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8207
Mailing Address - Country:US
Mailing Address - Phone:786-667-9228
Mailing Address - Fax:
Practice Address - Street 1:8711 SW 20TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8207
Practice Address - Country:US
Practice Address - Phone:786-667-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-309983106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician