Provider Demographics
NPI:1013145432
Name:PEREZ-GONZALEZ, IBET (SLP)
Entity type:Individual
Prefix:
First Name:IBET
Middle Name:
Last Name:PEREZ-GONZALEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13261 SW 251ST LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-2539
Mailing Address - Country:US
Mailing Address - Phone:786-333-9971
Mailing Address - Fax:305-503-7305
Practice Address - Street 1:13261 SW 251ST LN
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2539
Practice Address - Country:US
Practice Address - Phone:786-333-9971
Practice Address - Fax:305-503-7305
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14225235Z00000X
FLSA14225.235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI 1623OtherSLPA FLORIDA LICENSE