Provider Demographics
NPI:1497408876
Name:PERDOMO JOVER, MIGUEL EDUARDO
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:EDUARDO
Last Name:PERDOMO JOVER
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 1:14291 SW 267TH ST APT 106
Mailing Address - Street 2:
Mailing Address - City:NARANJA
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8279
Mailing Address - Country:US
Mailing Address - Phone:786-378-0472
Mailing Address - Fax:
Practice Address - Street 1:14291 SW 267TH ST APT 106
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8279
Practice Address - Country:US
Practice Address - Phone:786-378-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician