Provider Demographics
NPI:1467032987
Name:MATEO PEREZ, YOSVANI
Entity Type:Individual
Prefix:
First Name:YOSVANI
Middle Name:
Last Name:MATEO 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 1:29120 IDAHO RD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2731
Mailing Address - Country:US
Mailing Address - Phone:786-487-9048
Mailing Address - Fax:
Practice Address - Street 1:29120 IDAHO RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-2731
Practice Address - Country:US
Practice Address - Phone:786-487-9048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122991106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-122991OtherREGISTERED BEHAVIOR TECHNICIAN