Provider Demographics
NPI:1639922537
Name:TIA PEREZ, MARISLEIVYS CARIDAD
Entity Type:Individual
Prefix:
First Name:MARISLEIVYS
Middle Name:CARIDAD
Last Name:TIA PEREZ
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 1:10501 SW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-5649
Mailing Address - Country:US
Mailing Address - Phone:786-532-7622
Mailing Address - Fax:
Practice Address - Street 1:10501 SW 48TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5649
Practice Address - Country:US
Practice Address - Phone:786-532-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-328908106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician