Provider Demographics
NPI:1992385074
Name:PEREZ ALBA, AIXA
Entity Type:Individual
Prefix:
First Name:AIXA
Middle Name:
Last Name:PEREZ ALBA
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 1:15780 SW 148TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-5704
Mailing Address - Country:US
Mailing Address - Phone:305-762-0840
Mailing Address - Fax:
Practice Address - Street 1:13012 SW 85TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-6502
Practice Address - Country:US
Practice Address - Phone:305-762-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL862865993Medicaid