Provider Demographics
NPI:1598817280
Name:PEREZ, VIVIAN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR E
Mailing Address - Street 2:#383
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2708
Mailing Address - Country:US
Mailing Address - Phone:305-819-5500
Mailing Address - Fax:305-200-1226
Practice Address - Street 1:6625 MIAMI LAKES DR E
Practice Address - Street 2:#383
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-819-5500
Practice Address - Fax:305-200-1226
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical