Provider Demographics
NPI:1760949960
Name:VILA PEREZ, IDANAY
Entity Type:Individual
Prefix:
First Name:IDANAY
Middle Name:
Last Name:VILA 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 1:135 E 9TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4237
Mailing Address - Country:US
Mailing Address - Phone:786-362-0596
Mailing Address - Fax:
Practice Address - Street 1:459 NW 132ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1629
Practice Address - Country:US
Practice Address - Phone:305-898-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FLRBT-24-342768106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No253Z00000XAgenciesIn Home Supportive Care