Provider Demographics
NPI:1518646348
Name:PEREZ GONZALEZ, ROSA ELENA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ELENA
Last Name:PEREZ GONZALEZ
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 1:5136 KENSINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2734
Mailing Address - Country:US
Mailing Address - Phone:954-469-8899
Mailing Address - Fax:
Practice Address - Street 1:5136 KENSINGTON CIR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-2734
Practice Address - Country:US
Practice Address - Phone:954-469-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-282434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician