Provider Demographics
NPI:1477813624
Name:PEREZ, ANGELICA MARTINEZ (BA)
Entity Type:Individual
Prefix:MISS
First Name:ANGELICA
Middle Name:MARTINEZ
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 165054
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116
Mailing Address - Country:US
Mailing Address - Phone:305-668-8644
Mailing Address - Fax:305-675-7677
Practice Address - Street 1:6601 SW 80TH STREET
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-668-8644
Practice Address - Fax:305-675-7677
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst