Provider Demographics
NPI:1669038279
Name:PEREZ CORCHO GONZALEZ, JANET
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:PEREZ CORCHO GONZALEZ
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 1:9379 NW 114TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4269
Mailing Address - Country:US
Mailing Address - Phone:786-817-5020
Mailing Address - Fax:
Practice Address - Street 1:9379 NW 114TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4269
Practice Address - Country:US
Practice Address - Phone:786-817-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-78447106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician