Provider Demographics
NPI:1790517688
Name:PEREZ CRUZ, GABRIELA MARY
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MARY
Last Name:PEREZ CRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:MARY
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6215 W 22ND CT APT 19
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3985
Mailing Address - Country:US
Mailing Address - Phone:786-797-7670
Mailing Address - Fax:
Practice Address - Street 1:6215 W 22ND CT APT 19
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-3985
Practice Address - Country:US
Practice Address - Phone:786-797-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-353699106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician