Provider Demographics
NPI:1003602574
Name:PEREZ ORDAZ, YOLAISY Y
Entity type:Individual
Prefix:
First Name:YOLAISY
Middle Name:Y
Last Name:PEREZ ORDAZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 NW 2ND PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-4179
Mailing Address - Country:US
Mailing Address - Phone:239-744-9728
Mailing Address - Fax:
Practice Address - Street 1:2204 NW 2ND PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-4179
Practice Address - Country:US
Practice Address - Phone:239-744-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-350056106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician