Provider Demographics
NPI:1477377422
Name:RODRIGUEZ PEREZ, JACNERY
Entity type:Individual
Prefix:
First Name:JACNERY
Middle Name:
Last Name:RODRIGUEZ 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 1:21395 NW9 CT
Mailing Address - Street 2:6104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169
Mailing Address - Country:US
Mailing Address - Phone:305-766-2063
Mailing Address - Fax:
Practice Address - Street 1:3850 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1604
Practice Address - Country:US
Practice Address - Phone:305-744-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT5063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health