Provider Demographics
NPI:1801410196
Name:CORREDOR PEREZ, TAMARA I
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:I
Last Name:CORREDOR 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 1:3338 ROBERT TRENT JONES DR UNIT 406
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2381
Mailing Address - Country:US
Mailing Address - Phone:407-963-8953
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 115
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4644
Practice Address - Country:US
Practice Address - Phone:407-483-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty