Provider Demographics
NPI:1952070484
Name:PEREZ, MARINAI
Entity Type:Individual
Prefix:
First Name:MARINAI
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARINAI
Other - Middle Name:
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:241 SW 57TH AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:786-499-8682
Mailing Address - Fax:
Practice Address - Street 1:241 SW 57TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3400
Practice Address - Country:US
Practice Address - Phone:786-499-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-172146106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111743200Medicaid