Provider Demographics
NPI:1295505527
Name:PEREZ, KALAYAAN ANJULI GATUSLAO
Entity type:Individual
Prefix:
First Name:KALAYAAN ANJULI
Middle Name:GATUSLAO
Last Name: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 1:4726 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1179
Mailing Address - Country:US
Mailing Address - Phone:352-871-4260
Mailing Address - Fax:
Practice Address - Street 1:4726 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1179
Practice Address - Country:US
Practice Address - Phone:352-871-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician