Provider Demographics
NPI:1780200410
Name:ECHEMENDIA PEREZ, ANABEL
Entity Type:Individual
Prefix:
First Name:ANABEL
Middle Name:
Last Name:ECHEMENDIA 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 1:9941 DOMINICAN DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1624
Mailing Address - Country:US
Mailing Address - Phone:305-781-5957
Mailing Address - Fax:
Practice Address - Street 1:9941 DOMINICAN DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1624
Practice Address - Country:US
Practice Address - Phone:305-781-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-121140106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician