Provider Demographics
NPI:1598454704
Name:PERAZA MIGUEZ, ELENA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:PERAZA MIGUEZ
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 1:21701 INGRAHAM AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1016
Mailing Address - Country:US
Mailing Address - Phone:786-910-6018
Mailing Address - Fax:
Practice Address - Street 1:21701 INGRAHAM AVENUE RD
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1016
Practice Address - Country:US
Practice Address - Phone:786-910-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-263737103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst