Provider Demographics
NPI:1518676220
Name:PEREZ PARDO, YURISEL J
Entity Type:Individual
Prefix:
First Name:YURISEL
Middle Name:J
Last Name:PEREZ PARDO
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 1:5720 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6118
Mailing Address - Country:US
Mailing Address - Phone:786-609-2725
Mailing Address - Fax:
Practice Address - Street 1:240 W PALMETTO PARK RD STE 300C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3761
Practice Address - Country:US
Practice Address - Phone:561-430-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-212963106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician