Provider Demographics
NPI:1821691767
Name:TEJEDA PEREZ, ROSALI DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:ROSALI
Middle Name:DE LA CARIDAD
Last Name:TEJEDA 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 1:10250 SW 56TH ST STE A202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-7095
Mailing Address - Country:US
Mailing Address - Phone:888-527-8037
Mailing Address - Fax:
Practice Address - Street 1:10250 SW 56TH ST STE A202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7095
Practice Address - Country:US
Practice Address - Phone:888-527-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-122033106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician