Provider Demographics
NPI:1689116022
Name:PEREZ, KENIA
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KENIA
Other - Middle Name:
Other - Last Name:PEREZ MORALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17444 NW 76TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6167
Mailing Address - Country:US
Mailing Address - Phone:305-748-1045
Mailing Address - Fax:
Practice Address - Street 1:17444 NW 76TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6167
Practice Address - Country:US
Practice Address - Phone:305-748-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician