Provider Demographics
NPI:1700394517
Name:PEREZ, ALINA
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:
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 1:1550 MADRUGA AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3070
Mailing Address - Country:US
Mailing Address - Phone:786-467-7006
Mailing Address - Fax:
Practice Address - Street 1:7221 NW 174TH TER APT 101
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-1106
Practice Address - Country:US
Practice Address - Phone:201-724-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP620000695840Medicaid