Provider Demographics
NPI:1295124360
Name:PEREZ, DOUGLAS (BCBA)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 TO TO LO CHEE DR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5239
Mailing Address - Country:US
Mailing Address - Phone:305-773-4037
Mailing Address - Fax:305-901-1797
Practice Address - Street 1:321 TO TO LO CHEE DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5239
Practice Address - Country:US
Practice Address - Phone:305-773-4037
Practice Address - Fax:305-901-1797
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013511900Medicaid
FL017433800Medicaid