Provider Demographics
NPI:1629582804
Name:PEREZ CEPERO, YURALYS
Entity Type:Individual
Prefix:MRS
First Name:YURALYS
Middle Name:
Last Name:PEREZ CEPERO
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 1:10300 SW 24TH ST APT C33
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7978
Mailing Address - Country:US
Mailing Address - Phone:786-318-7094
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 24TH ST APT C33
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7978
Practice Address - Country:US
Practice Address - Phone:786-318-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-26
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18-73757106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician