Provider Demographics
NPI:1720627896
Name:PEREZ RIVERO, RACHELL
Entity Type:Individual
Prefix:
First Name:RACHELL
Middle Name:
Last Name:PEREZ RIVERO
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 1:18324 NW 68TH AVE APT I
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3424
Mailing Address - Country:US
Mailing Address - Phone:615-506-9978
Mailing Address - Fax:
Practice Address - Street 1:18324 NW 68TH AVE APT I
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3424
Practice Address - Country:US
Practice Address - Phone:615-506-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician