Provider Demographics
NPI:1255176822
Name:MUJICA PEREZ, MAIKOL JESUS
Entity type:Individual
Prefix:
First Name:MAIKOL
Middle Name:JESUS
Last Name:MUJICA PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 MISS PINEY RD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-2606
Mailing Address - Country:US
Mailing Address - Phone:561-285-8944
Mailing Address - Fax:
Practice Address - Street 1:4381 MISS PINEY RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-2606
Practice Address - Country:US
Practice Address - Phone:561-285-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician