Provider Demographics
NPI:1932648151
Name:PEREZ RODRIGUEZ, HORTENCIA M
Entity Type:Individual
Prefix:
First Name:HORTENCIA
Middle Name:M
Last Name:PEREZ RODRIGUEZ
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 1:6305 W 22ND CT
Mailing Address - Street 2:APT-101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3994
Mailing Address - Country:US
Mailing Address - Phone:786-663-9503
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:6305 W 22ND CT
Practice Address - Street 2:APT-101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3994
Practice Address - Country:US
Practice Address - Phone:786-663-9503
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician