Provider Demographics
NPI:1922873264
Name:PITA PEREZ, ANICET
Entity Type:Individual
Prefix:
First Name:ANICET
Middle Name:
Last Name:PITA 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 1:22931 SW 88TH PL UNIT 205
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-2034
Mailing Address - Country:US
Mailing Address - Phone:786-843-5193
Mailing Address - Fax:
Practice Address - Street 1:22931 SW 88TH PL UNIT 205
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-2034
Practice Address - Country:US
Practice Address - Phone:786-843-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23310999106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician