Provider Demographics
NPI:1720865702
Name:FERNANDEZ PEREZ, CARLA CAMILA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:CAMILA
Last Name:FERNANDEZ 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 1:13477 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7135
Mailing Address - Country:US
Mailing Address - Phone:305-988-2826
Mailing Address - Fax:
Practice Address - Street 1:13477 SW 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7135
Practice Address - Country:US
Practice Address - Phone:305-988-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT23295510106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician