Provider Demographics
NPI:1205447711
Name:PEREZ CARDERO, IRMA E
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:E
Last Name:PEREZ CARDERO
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 1:2775 W OKEECHOBEE RD LOT 26A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-1060
Mailing Address - Country:US
Mailing Address - Phone:786-718-7014
Mailing Address - Fax:
Practice Address - Street 1:2775 W OKEECHOBEE RD LOT 26A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-1060
Practice Address - Country:US
Practice Address - Phone:786-718-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-120543106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician