Provider Demographics
NPI:1245953462
Name:PEDRAZA PEREZ, MEILA
Entity type:Individual
Prefix:
First Name:MEILA
Middle Name:
Last Name:PEDRAZA PEREZ
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 1:14408 SW 280TH ST APT 101
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8405
Mailing Address - Country:US
Mailing Address - Phone:305-345-2344
Mailing Address - Fax:
Practice Address - Street 1:14408 SW 280TH ST APT 101
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8405
Practice Address - Country:US
Practice Address - Phone:305-345-2344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-234159106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician