Provider Demographics
NPI:1770276792
Name:PEREZ HERNANDEZ, LEYDI
Entity type:Individual
Prefix:
First Name:LEYDI
Middle Name:
Last Name:PEREZ HERNANDEZ
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 1:10893 SW 3RD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1473
Mailing Address - Country:US
Mailing Address - Phone:786-326-4886
Mailing Address - Fax:
Practice Address - Street 1:10893 SW 3RD ST APT 7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1473
Practice Address - Country:US
Practice Address - Phone:786-326-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty