Provider Demographics
NPI:1770230849
Name:PEGUERO DE LEON, HECTOR GREGORIO
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:GREGORIO
Last Name:PEGUERO DE LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 NW 23RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5332
Mailing Address - Country:US
Mailing Address - Phone:786-326-2050
Mailing Address - Fax:
Practice Address - Street 1:18200 NE 7TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1160
Practice Address - Country:US
Practice Address - Phone:305-651-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FLRBT-20-120318103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician