Provider Demographics
NPI:1609385525
Name:PEREZ FALCO, MARITZA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:PEREZ FALCO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22823 SW 113TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7575
Mailing Address - Country:US
Mailing Address - Phone:305-588-8346
Mailing Address - Fax:
Practice Address - Street 1:22823 SW 113TH PATH
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-7575
Practice Address - Country:US
Practice Address - Phone:305-588-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017604100Medicaid
FL1-20-43086Medicaid
FL0-17-8021Medicaid