Provider Demographics
NPI:1457786238
Name:PERAZA, MIRELIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MIRELIS
Middle Name:
Last Name:PERAZA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 S PALM DR
Mailing Address - Street 2:APT 524
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4533
Mailing Address - Country:US
Mailing Address - Phone:954-243-5038
Mailing Address - Fax:
Practice Address - Street 1:2214 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6702
Practice Address - Country:US
Practice Address - Phone:954-927-9555
Practice Address - Fax:954-921-4604
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9014103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist