Provider Demographics
NPI:1790396133
Name:PEREZ, PAOLA NICOLE (BSW)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:NICOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 WILSHIRE WAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7358
Mailing Address - Country:US
Mailing Address - Phone:954-512-3158
Mailing Address - Fax:407-210-8443
Practice Address - Street 1:3618 WILSHIRE WAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7358
Practice Address - Country:US
Practice Address - Phone:954-512-3158
Practice Address - Fax:407-210-8443
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator