Provider Demographics
NPI:1700472552
Name:PEREZ GONZALEZ, MILEIDYS
Entity Type:Individual
Prefix:
First Name:MILEIDYS
Middle Name:
Last Name:PEREZ GONZALEZ
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 1:24201 SW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4205
Mailing Address - Country:US
Mailing Address - Phone:786-873-2390
Mailing Address - Fax:
Practice Address - Street 1:24201 SW 123RD AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4205
Practice Address - Country:US
Practice Address - Phone:786-873-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20147012106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician