Provider Demographics
NPI:1942819586
Name:PEREZ RODRIGUEZ, JULIO CESAR
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:PEREZ RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8307 SW 142ND AVE APT F103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4013
Mailing Address - Country:US
Mailing Address - Phone:305-587-0657
Mailing Address - Fax:
Practice Address - Street 1:8307 SW 142ND AVE APT F103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4013
Practice Address - Country:US
Practice Address - Phone:305-587-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-128898106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician