Provider Demographics
NPI:1356117873
Name:ROJO PEREZ, FIDEL
Entity type:Individual
Prefix:
First Name:FIDEL
Middle Name:
Last Name:ROJO 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 1:113 CURTISS PKWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5220
Mailing Address - Country:US
Mailing Address - Phone:305-572-8960
Mailing Address - Fax:786-522-7204
Practice Address - Street 1:113 CURTISS PKWY
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5220
Practice Address - Country:US
Practice Address - Phone:305-572-8960
Practice Address - Fax:786-522-7204
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-312234106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician