Provider Demographics
NPI:1467179317
Name:ESTEFANO PEREIRO, IGNACIO
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:ESTEFANO PEREIRO
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 1:1579 QUAIL LAKE DR APT E310
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-4614
Mailing Address - Country:US
Mailing Address - Phone:561-906-3128
Mailing Address - Fax:
Practice Address - Street 1:1579 QUAIL LAKE DR APT E310
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-4614
Practice Address - Country:US
Practice Address - Phone:561-906-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLE231400990070106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician