Provider Demographics
NPI:1538678529
Name:PEREZ PEREZ, ANDY JAVIER
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:JAVIER
Last Name:PEREZ PEREZ
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 1:6031 W FLAGLER ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3269
Mailing Address - Country:US
Mailing Address - Phone:786-440-9625
Mailing Address - Fax:
Practice Address - Street 1:6031 W FLAGLER ST APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3269
Practice Address - Country:US
Practice Address - Phone:786-440-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician