Provider Demographics
NPI:1699399683
Name:PEREZ GONZALEZ, JORGE LUIS (RBT, BCABA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:LUIS
Last Name:PEREZ GONZALEZ
Suffix:
Gender:M
Credentials:RBT, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12257 SW 10TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2444
Mailing Address - Country:US
Mailing Address - Phone:305-399-6112
Mailing Address - Fax:
Practice Address - Street 1:12257 SW 10TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2444
Practice Address - Country:US
Practice Address - Phone:305-399-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-15087106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst